Effect of Intubation Timing on the Outcome of Patients With Severe Respiratory Distress Secondary to COVID-19 Pneumonia

Fayed, Mohamed; Patel, Nimesh; Yeldo, Nicholas; Nowak, Katherine; Penning, Donald H.; Torres, Felipe Vasconcelos; Natour, Abdul Kader; Chhina, Anoop

doi:10.7759/cureus.19620

Cited by 25 publications

(43 citation statements)

References 21 publications

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“…These results are interesting, and other recent evidence is pointing towards benefits of early intubation in COVID-19 patients [ 2 ], in contrast with previous findings published by the journal [ 3 ]. Indeed, a recent meta-analysis investigated this topic including 12 studies and almost 9000 COVID-19 patients.…”

contrasting

confidence: 47%

Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

et al. 2022

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contrasting

confidence: 47%

Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

et al. 2022

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“…Our study examined the characteristics of three barrier devices with respect to perceived ease of usage, time of intubation or device set up, and time to complete intubation and ventilation. In addition, we were able to evaluate the impact any of these barrier devices had on the ability to quickly and successfully perform intubations which has the potential to affect patient outcomes [ 18 ]. Although there have been several studies examining the logistics and feasibility of various barrier devices, our study additionally explores the usability of these devices from the perspective of physicians who are most likely to use them.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Characteristics of Intubation Airway Barrier Devices Using a Simulated Airway Task Trainer

Stuempfig¹,

Toulouie²,

Durant³

et al. 2022

Cureus

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Background: With the advent of variant strains such as Delta and Omicron, there have been renewed concerns regarding transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease 2019 (COVID-19)) disease to healthcare professionals, particularly during intubation procedures. Several forms of barrier protection aimed at decreasing the spread of aerosolized droplets were developed during the early onset of the pandemic.Objectives: Using a simulated airway model, we examined the impact that three separate barrier devices had on intubation time and success using both direct and video laryngoscopy. We hypothesized that the functionally simplistic devices would be preferred and would allow for faster intubations.Methods: Just-in-time training sessions focusing on COVID-19 intubations were set up between March and June of 2020. Sixty-seven emergency physicians and anesthesiologists participated. For a subset of physicians, exact times to barrier device setup and both direct and indirect intubations using three different barrier devices were recorded. Subsequently, physicians were asked to fill out a survey regarding their experiences.Results: The survey response rate was 60%. In general, this cohort preferred a plain clear plastic drape or clear plastic drape with polyvinyl chloride (PVC) cube for direct laryngoscopy and video laryngoscopy setups. The use of these two devices resulted in significantly faster times to completed intubation when compared with the fiberglass box while using a simulated task trainer. Conclusion:In general, a simple, plastic sheet was the preferred barrier device using video laryngoscopy. Although setup times were faster using the fiberglass box, intubation times were significantly faster using the plastic drape or PVC frame.

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“…However, post hoc analysis of patients who had SOFA scores between 0 and 9 showed that significantly more patients within this score range who were intubated late died compared to those who were intubated early. Additionally, Kaplan–Meier survival analysis stratified by SOFA score also showed that patients who were intubated later were more likely to die [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

et al. 2022

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Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005–1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).

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Effect of Intubation Timing on the Outcome of Patients With Severe Respiratory Distress Secondary to COVID-19 Pneumonia

Cited by 25 publications

References 21 publications

Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

Comparison of the Characteristics of Intubation Airway Barrier Devices Using a Simulated Airway Task Trainer

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

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