Delayed intubation is associated with mortality in patients with severe COVID-19: A single-centre observational study in Switzerland

Terrier, Christophe Le; Suh, Noémie; Wozniak, Hannah; Boroli, Filippo; Giudicelli-Bailly, Amélie; Sangla, Frédéric; Legouis, David; Bendjelid, Karim; Quintard, Hervé; Pugin, Jérôme

doi:10.1016/j.accpm.2022.101092

Cited by 16 publications

(16 citation statements)

References 32 publications

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“…SARS-CoV-2-related symptoms vary from mild with fever, coughing, headaches and myalgia, to severe with life-threatening hypoxic respiratory failure [ 6 ]. In critically ill adult patients, severe acute respiratory syndrome (SARS) is the main cause of organ failure and the need for invasive mechanical ventilation (IMV) is often required [ 7 , 8 ]. The main complication of prolonged intubation is ventilator-acquired pneumonia (VAP).…”

Section: Introductionmentioning

confidence: 99%

Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France

Moreno¹,

Carvelli

Lesaux³

et al. 2023

JCM

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Describe the characteristics of ventilation-acquired pneumonia (VAP) and potential risk factors in critically ill Sars-Cov-2 patients admitted in three French public hospitals during the first year of the COVID-19 pandemic. We conducted a monocentric retrospective study in seven Marseille intensive care units (ICUs) aiming to describe VAP characteristics and identify their risk factors. VAP patients were compared to a non-VAP control group. From March to November 2020, 161 patients admitted for viral-induced acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV) were included. This cohort was categorized in two groups according to the development or not of a VAP during their stay in ICU. 82 patients (51%) developed ventilation-acquired pneumonia. Most of them were men (77%) and 55% had hypertension. In the VAP population, 31 out of 82 patients (38%) had received dexamethasone and 47% were administered antibiotic course prior to ICU admission. An amount of 88% of respiratory infections were late VAPs with a median delay of 10 days from the onset of IMV. Gram negative bacteria were responsible for 62% of VAPs with Pseudomonas spp. being the most documented bacteria. Less than a third of the ICU-acquired infections were due to multidrug resistant (MDR) bacteria mainly displaying AmpC cephalosporin hyper production resistance phenotype. Multivariate analysis revealed that early Dexamethasone administration in ICU, male sex, older age and ROX score were risk factors for VAP whereas pre-ICU antimicrobial treatment and higher IGS 2 were protective factors. VAP is a frequent ICU-related complication affecting half of patients infected with Sars-Cov-2 and requiring IMV. It was responsible for increased morbidity due to a longer ICU and hospital stay. VAP risk factors included demographic factors such as age and sex. Dexamethasone was associated with a threefold greater risk of developing VAP during ICU stay. These results need to be comforted by large multi-centric studies before questioning the only available and effective treatment against Sars-Cov-2 in ICU patients.

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Section: Introductionmentioning

confidence: 99%

Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France

Moreno¹,

Carvelli

Lesaux³

et al. 2023

JCM

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“…In the later waves 2/3, overall oxygen method utilization reflects higher proportions of patients managed using HFNC during the first week of hospitalization. These results add a broader perspective of hospitalizations inclusive of all care units 33 . Further analyses describing practice patterns and assessing outcomes associated with delayed intubation specific to COVID-19 are warranted.…”

Section: Changes In Clinical Practice Over Time May Have Influenced O...mentioning

confidence: 68%

Daily Oxygenation Support for Patients Hospitalized With SARS-CoV-2 in an Integrated Health System

et al. 2022

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“…At that time, patient triage, timely treatment, the timing of intubation, and ICU admission remained a matter of debate in patients depending on their severity [ 13 , 28 ]. Yet, delaying their timely treatment was associated with a poorer prognosis and increased mortality, partly because delaying the proper and timely treatment of inflamed lungs in hypoxemic patients with vigorous spontaneous respiratory effort promotes self-inflicted lung injury [ 29 ]. In parallel, high demand on critical and emergency services also increased mortality for patients with critical COVID-19, both in the early and later stages of the pandemic [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19

Alamé

Lemaitre

Vuillaume

et al. 2022

JCM

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Introduction: Understanding hypoxemia, with and without the clinical signs of acute respiratory failure (ARF) in COVID-19, is key for management. Hence, from a population of critical patients admitted to the emergency department (ED), we aimed to study silent hypoxemia (Phenotype I) in comparison to symptomatic hypoxemia with clinical signs of ARF (Phenotype II). Methods: This multicenter study was conducted between 1 March and 30 April 2020. Adult patients who were presented to the EDs of nine Great-Eastern French hospitals for confirmed severe or critical COVID-19, who were then directly admitted to the intensive care unit (ICU), were retrospectively included. Results: A total of 423 critical COVID-19 patients were included, out of whom 56.1% presented symptomatic hypoxemia with clinical signs of ARF, whereas 43.9% presented silent hypoxemia. Patients with clinical phenotype II were primarily intubated, initially, in the ED (46%, p < 0.001), whereas those with silent hypoxemia (56.5%, p < 0.001) were primarily intubated in the ICU. Initial univariate analysis revealed higher ICU mortality (29.2% versus 18.8%, p < 0.014) and in-hospital mortality (32.5% versus 18.8%, p < 0.002) in phenotype II. However, multivariate analysis showed no significant differences between the two phenotypes regarding mortality and hospital or ICU length of stay. Conclusions: Silent hypoxemia is explained by various mechanisms, most physiological and unspecific to COVID-19. Survival was found to be comparable in both phenotypes, with decreased survival in favor of Phenotype II. However, the spectrum of silent to symptomatic hypoxemia appears to include a continuum of disease progression, which can brutally evolve into fatal ARF.

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Delayed intubation is associated with mortality in patients with severe COVID-19: A single-centre observational study in Switzerland

Cited by 16 publications

References 32 publications

Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France

Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France

Daily Oxygenation Support for Patients Hospitalized With SARS-CoV-2 in an Integrated Health System

Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19

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