Clinical Outcomes of Early Versus Late Intubation in COVID-19 Patients

Al-Tarbasheh, Ali; Chong, Woon H.; Oweis, Jozef; Saha, Biplab K.; Feustel, Paul J.; Leanon, Annie; Chopra, Amit

doi:10.7759/cureus.21669

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…Though the risk of death in the present ICU cohort was high (42% overall and 78% in those who received mechanical ventilation) it was consistent with other cohorts from early in the pandemic. 21–23 Studies of later cohorts have reported mortality rates of 50% or lower in those with COVID-19 who are intubated, which is consistent with the reduction in mortality rate observed over time at The University of Michigan Health West. 22,23 Though the present results may be generalizable to other relatively small community health systems that provide the majority of health care in the USA, we should acknowledge other factors that may affect external validity.…”

Section: Discussionsupporting

confidence: 63%

“…21–23 Studies of later cohorts have reported mortality rates of 50% or lower in those with COVID-19 who are intubated, which is consistent with the reduction in mortality rate observed over time at The University of Michigan Health West. 22,23 Though the present results may be generalizable to other relatively small community health systems that provide the majority of health care in the USA, we should acknowledge other factors that may affect external validity. The present cohort consisted largely of obese, unvaccinated patients during the earlier phase of the pandemic.…”

Section: Discussionsupporting

confidence: 63%

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Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome

et al. 2022

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Objective To determine the incidence and significance of ventilator avoidance in patients with critical coronavirus disease 2019 (COVID-19). Methods This prospective observational cohort study evaluated hospital mortality and 1-year functional outcome among critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated acute respiratory distress syndrome (ARDS). The explanatory variable was ventilator avoidance, modeled as ‘initial refusal’ of intubation (yes/no). Modified Rankin Scale (mRS) scores were obtained from surviving patients (or their surrogates) via phone or email questionnaire. Results Among patients for whom intubation was recommended ( n = 102), 40 (39%) initially refused (95% confidence interval [CI] 30%, 49%). The risk of death was 79.3% (49/62) in those who did not initially refuse intubation compared with 77.5% (31/40) in those who initially refused, with an adjusted odds ratio for death of 1.27 (95% CI 0.47, 3.48). The distribution of 1-year mRS scores was not significantly different between groups. Conclusion Among critically ill patients with COVID-19-associated ARDS, ventilator avoidance was common, but was not associated with increased in-hospital mortality or 1-year functional outcome.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 63%

Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome

et al. 2022

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“…Therefore, most patients already had severe ARDS once placed on mechanical ventilation. However, studies on timing to intubation did not affect mortality (Papoutsi et al, 2021;Al-Tarbsheh et al, 2022). This may be due to self-injurious lung injury in spontaneously breathing patients, that is akin to ventilator induced lung injury (Weaver et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine, azithromycin and methylprednisolone and in hospital survival in severe COVID-19 pneumonia

Nyirenda²

2022

Front. Pharmacol.

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Introduction: Severe COVID-19 pneumonia has two phases that are not mutually exclusive. Repurposed drugs target only one phase and the association of combination therapy to survival is unknown.Objective: To determine the association of hydroxychloroquine, azithromycin, and methylprednisolone versus methylprednisolone only to in hospital survival.Methods: This is a secondary analysis of a retrospective cohort of patients admitted for severe covid-19 in 13 hospitals in New Jersey, United States from March–June 2020. Propensity score match with 11 variables was constructed between those who received no methylprednisolone and methylprednisolone. Multivariate Cox regression was used for risk of in hospital mortality.Measurements and main results: There were 759 patients, 380 in no methylprednisolone and 379 with methylprednisolone. Multivariate Cox regression shows that methylprednisolone, hydroxychloroquine, and azithromycin had prolonged survival compared to methylprednisolone alone [HR 0.45 (95% CI 0.22,0.91 p < 0.03)]. In patients who received hydroxychloroquine and azithromycin, those who also received high dose methylprednisolone were associated with worse survival compared to those who received low dose methylprednisolone (HR = 1.642; 95% CI 1.053 to 2.562; p = 0.0287). Nursing home residents [HR 2.77 (95% CI 1.67, 4.59 p < 0.0001)], coronary artery disease [HR 2.93 (95% CI 1.31, 3.15 p = 0.001), and invasive mechanical ventilation [HR 3.02 (95% CI 1.71,5.34 p = 0.0001)] were independently associated with worse survival.Conclusion: Combination therapy was associated with improved survival compared to monotherapy. However, nursing home residents, coronary artery disease, and mechanical ventilation were independently associated with mortality. Larger randomized controlled studies are needed to confirm conclusions.

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“…This has placed a heavy burden on the healthcare system around the world. Earlier studies and observations, including one metanalysis [ 8 ], did not reveal a significant difference in mortality comparing early intubation to late intubation strategy in a COVID-19 patient, taking into consideration that most of the early intubated group were defined as patients who required intubation within 24 hours of hospital admission [ 9 , 10 ]. In our cohort, we defined the early intubation group as patients who require intubation within 72 hours of hospital admission to evaluate the mortality outcome and the mortality predictor of early and late intubation groups.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of COVID-19-Induced Acute Respiratory Distress Syndrome in Patients With Three Different Respiratory Support Modalities: A Retrospective Cohort Study

Alamami¹,

Imaduddeen²,

Ibrahim³

et al. 2022

Cureus

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IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced acute respiratory failure and acute respiratory distress syndrome (ARDS) had a considerable impact on intensive care utilization and resource optimization. Multiple modalities for respiratory support were implemented during the COVID-19 pandemic with the main concern of being able to identify those patients at high risk of rapidly progressive respiratory failure, whom the early initiation of invasive respiratory support would, in particular, affect the outcome in comparison to the noninvasive management strategy. ObjectivesIn our cohort study, we describe demographic characteristics, respiratory support modalities, and their relation to patient outcomes. MethodPatients 18 years of age and older who were admitted to a tertiary center COVID-19-dedicated medical intensive care unit (MICU) in Qatar between March 2020 and May 2020 with a confirmed diagnosis of COVID-19 pneumonia were included in this study. Patients were divided into invasive or noninvasive, and those who required invasive strategy were subdivided into the early intubation group (patients who were intubated within 72 hours of intensive care unit (ICU) admission) and the late intubation group (patients who were intubated after 72 hours from ICU admission). The primary outcome was ICU and hospital mortality, and the secondary effects were the length of stay and mortality determinants. ResultsA total of 686 patients were admitted to the medical intensive care unit (MICU) during the study period. There were 222 (32.4%), 131 (19.1%), and 333 (48.5%) patients in the early, late, and not intubated groups, respectively. Compared to the late intubated group, the early intubated group had a higher proportion of males. Diabetes (39.8%) was the most common comorbidity, followed by hypertension (HTN) (36%) and heart disease (9.8%). The 30-day ICU and hospital mortality were significantly higher in the late intubated group compared to the early intubated group (30.5% versus 15.8%, and 30% versus 16.2%). The median ICU and hospital stay days in the total sample were 8 (interquartile range (IQR): 5-14) and 19 (IQR: 14-25), respectively. The mean estimates of 30-day ICU survival times for early intubated, late intubated, and not intubated groups were 25.

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Clinical Outcomes of Early Versus Late Intubation in COVID-19 Patients

Cited by 6 publications

References 30 publications

Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome

Ventilator avoidance among critically ill COVID-19 patients with acute respiratory distress syndrome

Hydroxychloroquine, azithromycin and methylprednisolone and in hospital survival in severe COVID-19 pneumonia

Clinical Outcomes of COVID-19-Induced Acute Respiratory Distress Syndrome in Patients With Three Different Respiratory Support Modalities: A Retrospective Cohort Study

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