Early Intubation and Increased Coronavirus Disease 2019 Mortality: A Propensity Score–Matched Retrospective Cohort Study

Parish, Austin J; West, Jason R.; Caputo, Nicholas D.; Janus, Trevor M.; Yuan, Denley Ming Kee; Zhang, Junyi; Singer, Daniel J.

doi:10.1097/cce.0000000000000452

Cited by 10 publications

(17 citation statements)

References 50 publications

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“…Four prospective cohort studies [ 16 , 27 , 31 , 33 ] included 504 patients (sample size range, 32–205), and eight retrospective cohort studies [ 14 , 15 , 17 , 26 , 28 – 30 , 32 ] included 2,339 patients (sample size range, 39–1618). Six studies [ 14 , 15 , 26 , 28 , 30 , 32 ] were performed in the US, three [ 27 , 31 , 33 ] in Europe, two [ 17 , 29 ] in Asia, and one [ 16 ] in Chile. Seven studies [ 14 – 17 , 26 , 30 , 33 ] were single-center studies, while the others were multi-center studies.…”

Section: Resultsmentioning

confidence: 99%

“…The index time for intubation was defined according to the onset of acute respiratory failure in five studies [ 15 , 26 , 29 , 30 , 33 ] and ICU admission in three studies [ 17 , 28 , 31 ]. Five studies [ 14 , 26 , 28 , 29 , 31 ] defined early intubation as intubation within 24 h and five studies [ 16 , 17 , 27 , 30 , 32 ] as within 48 h from the index time.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [ 14 , 26 , 28 , 29 , 31 ] defined early intubation as intubation within 24 h and five studies [ 16 , 17 , 27 , 30 , 32 ] as within 48 h from the index time.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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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).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [ 1 , 2 ]. It has spread very rapidly around the world, resulting in severe acute respiratory failure with less known pathophysiology [ 2 , 3 , 4 , 5 ]. It has increased its rate of transmission and critical illness with a higher risk of intensive care unit (ICU) admissions, producing a wide spectrum of mortality rates [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Early versus late intubation on the outcome of intensive care unit-admitted COVID-19 patients at Addis Ababa COVID-19 treatment centers, Addis Ababa, Ethiopia: A multicenter retrospective cohort study

Birhanu

Gemeda

Fekede

et al. 2022

International Journal of Surgery Open

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Background Coronavirus disease 2019 (COVID-19) has resulted in severe acute respiratory failure, requiring intubation and an invasive mechanical ventilation. However, the time for initiation of intubation remains debatable. Therefore, this study aimed to compare early and late intubation on the outcome of COVID-19 patients admitted to the intensive care unit (ICU) of selected Addis Ababa COVID-19 treatment centers, Ethiopia. Methods A multicenter retrospective cohort study was conducted on 94 early and late intubated ICU-admitted COVID-19 patients from October 1, 2020, to October 31, 2021, in three selected COVID-19 treatment centers in Addis Ababa, Ethiopia. A simple random sampling technique was used to select study participants. An independent t-test, Mann Whitney U test and Fisher’s exact test were used for statistical analysis, as appropriate. A P value < 0.05 was used to declare a statistical significance. Results A total of 94 patients participated, for a response rate of 94.68%. There was a statistically insignificant difference in the rates of death between the early intubated (47.2%) and the late intubated (46.1%) groups (P = 0.678). There was no difference in the median length of stay on a mechanical ventilator (in days) between the groups (P = 0.11). However, the maximum length of stay in the ICU to discharge was significantly shorter in the early intubated (33.1 days) than late intubated groups (63.79 days) (P < 0.001). Conclusion Outcomes (death or survival) were similar whether early or late intubation was used. Early intubation did appear to improve length of ICU stay in ICU-admitted COVID-19 patients. Highlights

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“…Other studies have reported that NIV might not influence the outcome or natural course of COVID-19 disease [ 9 ]. Invasive MV via a tracheal tube appears to be the most common approach after failed NIV but is associated with higher all-cause mortality in COVID-19 patients [ 10 , 11 , 12 ]. Contrasting results have been published regarding early intubation in terms of survival benefits [ 13 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

Rocans

Ozoliņa

Battaglini

et al. 2022

JCM

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Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.

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Early Intubation and Increased Coronavirus Disease 2019 Mortality: A Propensity Score–Matched Retrospective Cohort Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 10 publications

References 50 publications

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

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

Early versus late intubation on the outcome of intensive care unit-admitted COVID-19 patients at Addis Ababa COVID-19 treatment centers, Addis Ababa, Ethiopia: A multicenter retrospective cohort study

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

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