Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection

Matta, Atul; Chaudhary, Siddique; Lo, Kevin Bryan; DeJoy, Robert; Gul, Fahad; Torres, Ricardo; Chaisson, Neal F.; Patarroyo‐Aponte, Gabriel

doi:10.1097/cce.0000000000000262

Cited by 39 publications

(47 citation statements)

References 11 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Figure 1 shows the flow diagram for study selection. A total of 12 studies [13,14,[18][19][20][21][22][23][24][25][26][27] from Africa, Asia, Europe and America, involving 8944 critically ill patients (7639 early, 1305 late) with COVID-19, were incorporated in our meta-analysis. Table 1 and Additional file 1: Supplementary Table 2 summarize the characteristics and risk of bias assessment of the included studies, respectively.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

et al. 2021

View full text Add to dashboard Cite

Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

show abstract

Section: Resultsmentioning

confidence: 99%

“…All 12 studies [13,14,[18][19][20][21][22][23][24][25][26][27] provided data on all-cause mortality. No statistical heterogeneity was detected (I 2 = 0%).…”

Section: All-cause Mortalitymentioning

confidence: 99%

Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The authors concluded that larger cohort studies were needed to detect a difference in mortality between early and late intubation. Other studies have found no advantage for early or late intubation [ 27 , 30 ]. Current mortality data suggest an advantage for patients in whom intubation is completely avoided, but these data may be confounded.…”

Section: Resultsmentioning

confidence: 99%

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic – international recommendations and clinical experience

Assadian

Golling²,

Krüger

et al. 2021

Journal of Hospital Infection

View full text Add to dashboard Cite

Background The COVID-19 pandemic not only had an impact on public life and healthcare facilities in general, but also affected established surgical workflows for elective procedures. The strategy to protect patients and healthcare workers from infection by SARS-CoV-2 in surgical departments has needed step-by-step development. Based on the evaluation of international recommendations and guidelines, as well as personal experiences in a clinical “hot spot” and in a 450-bed surgical clinic, an adapted surgical site infection (SSI) prevention checklist was needed to develop concise instructions, which described roles and responsibilities of health care professionals that could be used for wider guidance in pandemic conditions. Method Publications of COVID-19-related recommendations and guidelines, produced by health authorities and organizations, such as WHO, US-CDC, ECDC, the American College of Surgery and the Robert Koch Institute, were retrieved, assessed and referenced up to January 31 st , 2020. Additionally, clinical personal experiences in Germany were evaluated and considered. Results Part 1 of this guidance summarizes the experience of a tertiary care, surgical centre which utilised redundant hospital buildings for immediate spatial separation in a “hot spot” COVID-19 area. Part 2 outlines the successful screening and isolation strategy in a surgical clinic in a region of Germany with outbreaks in surrounding medical centres. Part 3 provides the synopsis of personal experiences and international recommendations suggested for implementation during the COVID-19 pandemic. Conclusion Understanding of COVID-19, and SARS-CoV-2-related epidemiology, is constantly and rapidly changing, requiring continuous adaptation and re-evaluation of recommendations. Established national and local guidelines for continuation of surgical services and prevention of SSI require ongoing scrutiny and focused implementation. This manuscript presents a core facility checklist to support medical institutions to continue their clinical and surgical work during the COVID-19 pandemic.

show abstract

“…Later studies providing more complete outcome data had mortality rates from 17% to 36% ( 72 , 73 ). A recent retrospective study of 128 patients with COVID-19 did not find a mortality difference between patients who were intubated early or late in their hospital course ( 74 ). With the available respiratory support measures, it is reasonable to try a stepwise approach, monitoring oxygenation, ventilation, and work of breathing, and then intubating as one would in other clinical circumstances ( 70 ).…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Management of Severe Hypoxemic Respiratory Failure in Adults With COVID-19

Wilcox

Condella

2021

The Journal of Emergency Medicine

View full text Add to dashboard Cite

Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection

Abstract: Supplemental Digital Content is available in the text.

Cited by 39 publications

References 11 publications

Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic – international recommendations and clinical experience

Emergency Department Management of Severe Hypoxemic Respiratory Failure in Adults With COVID-19

Contact Info

Product

Resources

About