Early intubation and clinical outcomes in patients with severe COVID-19: a systematic review and meta-analysis

Abstract

Background Evidence regarding the timing of the application of mechanical ventilation among patients with severe coronavirus disease (COVID-19) is insufficient. This systematic review and meta-analysis aimed to evaluate the effectiveness of early intubation compared to late intubation in patients with severe and critical COVID-19. Methods For this study, we searched the MEDLINE, EMBASE, and Cochrane databases as well as one Korean domestic database on July 15, 2021. We updated the search monthly from September 10, 2021 to February 10, 2022. Studies that compared early intubation with late intubation in patients with severe COVID-19 were eligible for inclusion. Relative risk (RR) and mean difference (MD) were calculated as measures of effect using the random-effects model for the pooled estimates of in-hospital mortality, intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, ICU-free days, and ventilator-free days. Subgroup analysis was performed based on the definition of early intubation and the index time. To assess the risk of bias in the included studies, we used the Risk of Bias Assessment tool for Non-randomized studies 2.0. Results Of the 1523 records identified, 12 cohort studies, involving 2843 patients with severe COVID-19 were eligible. There were no differences in in-hospital mortality (8 studies, n = 795; RR 0.91, 95% CI 0.75–1.10, P = 0.32, I2 = 33%), LOS in the ICU (9 studies, n = 978; MD −1.77 days, 95% CI −4.61 to 1.07 days, P = 0.22, I2 = 78%), MV duration (9 studies, n = 1,066; MD −0.03 day, 95% CI −1.79 to 1.72 days, P = 0.97, I2 = 49%), ICU-free days (1 study, n = 32; 0 day vs. 0 day; P = 0.39), and ventilator-free days (4 studies, n = 344; MD 0.94 day, 95% CI −4.56 to 6.43 days, P = 0.74, I2 = 54%) between the early and late intubation groups. However, the early intubation group had significant advantage in terms of hospital LOS (6 studies, n = 738; MD −4.32 days, 95% CI −7.20 to −1.44 days, P = 0.003, I2 = 45%). Conclusion This study showed no significant difference in both primary and secondary outcomes between the early intubation and late intubation groups. Trial registration This study was registered in the Prospective Register of Systematic Reviews on 16 February, 2022 (registration number CRD42022311122).

Appropriate Endotracheal Tube Position for Percutaneous Dilatational Tracheostomy: A Single-Center Observational Study

“…Obesity is a risk factor for severe COVID-19 [ 20 , 21 ], and the disease has a high mortality rate. The mortality rate for patients intubated with COVID-19 has been reported to be 47.3% [ 22 ]. In this study, the median weight of patients with COVID-19 was 70.2 (61.1-80.8) kg, and 12 of the 17 in-hospital deaths in the derivation group were due to COVID-19 (70.6%).…”

Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves

“…A prospective observational study to assess the usefulness of a protocol in which patients were intubated for increased work of breathing after HFNC and awake prone manoeuvre found higher mortality in patients intubated > 48 h after ICU admission [ 33 ]. Finally, one of the latest meta-analyses published showed no statistical difference in terms of mortality between early and late intubation, however they analysed studies with different cut-off points and high heterogeneity, so the results must be interpreted with care [ 34 ]. The results obtained so far are contradictory, in part by the different cut-off points, wave patterns observed in the pandemic and intubation criteria in the studies analysed.…”

Two Years of Experience and Methodology of Korean COVID-19 Living Clinical Practice Guideline Development

“…We have also published several systematic reviews and meta-analyses in international journals, such as the rapid antigen test (RAT), interferon (type I and type III), interleukin-6 receptor antagonists (tocilizumab and sarilumab), early intubation, and prone position for patients with severe COVID-19. 13 14 15 16 17 Moreover, for information sharing with the international community, the guidelines were published at the Guideline International Network (2021 and 2022) conferences. Although it may be practically difficult to obtain data by monitoring changes in the use of interventions, such as medications, after the publication of practice guidelines in clinical practice, changes in the use of interventions that are confirmed through discussions by the steering committee will be monitored using publicly available national open health data.…”