Ventilatory Mechanics in Early vs Late Intubation in a Cohort of Coronavirus Disease 2019 Patients With ARDS

Pandya, A.; Kaur, Navjot; Sacher, D.; O'Corragain, O.A.; Salerno, Daniel; Desai, Parag; Sehgal, Sameep; Gordon, Matthew; Gupta, Rohit; Marchetti, Nathaniel; Zhao, Huaqing; Patlakh, N.; Criner, Gerard J.

doi:10.1016/j.chest.2020.08.2084

Cited by 40 publications

(65 citation statements)

References 9 publications

(9 reference statements)

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“…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%

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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

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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.

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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

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“…The final selection included 26 studies: 4 multicenter prospective cohort studies [17][18][19][20], 6 multicenter retrospective cohort studies [8,[21][22][23][24][25], 1 single center prospective cohort study [26], 1 multicenter prospective case series [27], 2 multicenter retrospective case series [28,29], 4 single center prospective case series [30][31][32][33] and 8 single center retrospective case series [34][35][36][37][38][39][40][41] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Mechanical ventilation parameters in critically ill COVID-19 patients: a scoping review

et al. 2021

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Background The mortality of critically ill patients with COVID-19 is high, particularly among those receiving mechanical ventilation (MV). Despite the high number of patients treated worldwide, data on respiratory mechanics are currently scarce and the optimal setting of MV remains to be defined. This scoping review aims to provide an overview of available data about respiratory mechanics, gas exchange and MV settings in patients admitted to intensive care units (ICUs) for COVID-19-associated acute respiratory failure, and to identify knowledge gaps. Main text PubMed, EMBASE, and MEDLINE databases were searched from inception to October 30, 2020 for studies providing at least one ventilatory parameter collected within 24 h from the ICU admission. The quality of the studies was independently assessed using the Newcastle–Ottawa Quality Assessment Form for Cohort Studies. A total of 26 studies were included for a total of 14,075 patients. At ICU admission, positive end expiratory pressure (PEEP) values ranged from 9 to 16.5 cm of water (cmH2O), suggesting that high levels of PEEP were commonly used for setting MV for these patients. Patients with COVID-19 are severely hypoxemic at ICU admission and show a median ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ranging from 102 to 198 mmHg. Static respiratory system compliance (Crs) values at ICU admission were highly heterogenous, ranging between 24 and 49 ml/cmH2O. Prone positioning and neuromuscular blocking agents were widely used, ranging from 17 to 81 and 22 to 88%, respectively; both rates were higher than previously reported in patients with “classical” acute respiratory distress syndrome (ARDS). Conclusions Available data show that, in mechanically ventilated patients with COVID-19, respiratory mechanics and MV settings within 24 h from ICU admission are heterogeneous but similar to those reported for “classical” ARDS. However, to date, complete data regarding mechanical properties of respiratory system, optimal setting of MV and the role of rescue treatments for refractory hypoxemia are still lacking in the medical literature.

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“…This depended on the availability of intensive-care beds. In a US single-centre comparative cohort study, the ventilatory parameters and lung mechanics of consecutive early and late intubated and ventilated patients with COVID-19 acute respiratory distress syndrome (ARDS), were measured using descriptive analysis [29]. The authors concluded that larger cohort studies were needed to detect a difference in mortality between early and late intubation.…”

Section: Covid-19 Infectionsmentioning

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

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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.

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Ventilatory Mechanics in Early vs Late Intubation in a Cohort of Coronavirus Disease 2019 Patients With ARDS

Cited by 40 publications

References 9 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

Mechanical ventilation parameters in critically ill COVID-19 patients: a scoping review

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

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