Intubation timing as determinant of outcome in patients with acute respiratory distress syndrome by SARS-CoV-2 infection

Abstract

Purpose To determine whether time-to-intubation was associated with higher ICU mortality in patients with COVID-19 on mechanical ventilation due to respiratory insufficiency. Materials and methods We conducted an observational, prospective, single-center study of patients with confirmed SARS-CoV-2 infection hospitalized with moderate to severe ARDS, connected to mechanical ventilation in the ICU between March 17 and July 31, 2020. We examined their general and clinical characteristics. Time-to-intubation was the time from hospital admission to endotracheal intubation. Results We included 183 consecutive patients; 28% were female, and median age was 62 years old. Eighty-eight patients (48%) were intubated before 48 h (early) and ninety-five (52%) after 48 h (late). Patients intubated early had similar admission PaO 2 /FiO 2 ratio (123 vs 99; p = 0.179) but were younger (59 vs 64; p = 0.013) and had higher body mass index (30 vs 28; p = 0.006) compared to patients intubated late. Mortality was higher in patients intubated late (18% versus 43%), with admission PaO 2 /FiO 2 ratio < 100 mmHg (OR 5.2; p = 0.011), of older age (OR 1.1; p = 0.001), and with previous use of ACE inhibitors (OR 4.8; p = 0.026). Conclusions In COVID-19 patients, late intubation, Pafi <100, older age, and previous ACE inhibitors use were associated with increased ICU mortality.

Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

“…Specifically, they found a 3% increase in mortality for each day of delay in intubation following hospital admission. In another study, the difference at intubation timing was 18% in < 48 h versus 43% in > 48 h ( p < 0.01) [ 33 ]. These results are consistent with our study and highlight the importance of not delaying intubation once patients develop CARDS.…”

Comparison of clinical characteristics and outcomes of COVID-19 patients undergoing early versus late intubation from initial hospital admission: A systematic review and meta-analysis

“…defined early intubation within 48 h from hospital admission. [ 5 , 6 ] Two studies by Hernandez-Romieu et al. and Mellado-Artigas et al.…”

“…[ 5 ] Vera et al. [ 6 ] Cohort Design Multi-center, Retrospective Multi-center, Prospective Single-center, Retrospective Single-center, Prospective Enrollment Period March–May 2020 March–August 2020 February–May 2020 March–July 2020 Country USA Spain USA Chile Total Patients (N) 118 122 75 183 Early Intubation Patients (N) 76 61 37 88 Demographics Age (Y), Mean ± SD 67.00±14.81 61.00±11.00 65.90±14.79 59.00±9.63 Male, N (%) 38 (50.0) 25 (40.9) 21 (48.8) 62 (70.5) Admission BMI (kg/m2), Mean ± SD 30.90±9.04 28.80±4.30 28.63±9.44 30.00±2.96 SOFA Score, Mean ± SD 10.50±2.59 5.00±2.96 NR 6.00±2.96 Comorbidity DM, N (%) 53 (69.7) NR NR 27 (30.7) Late Intubation Patients (N) 42 61 38 95 Demographics Age (Y), Mean ± SD 67.00±14.81 62.00±11.00 64.05±13.87 64.00±11.90 Male N (%) 25 (59.5) 34 (55.7) 22 (51.2) 70 (73.7) Admission BMI (kg/m2), Mean ± SD 30.50±6.67 28.80±5.50 34.16±8.51 <...>…”

Soporte ventilatorio en pacientes críticos con COVID-19:a 18 meses de la pandemia en Chile

“…En los estadios de mayor compromiso del intercambio ga-seoso, clásicamente ante Pa:Fio 2 < 150 mmHg, el uso de bloqueo neuromuscular (BNM) en infusión y el posicionamiento en prono ha mostrado ser seguros y efectivos, logrando una disminución ostensible en la mortalidad de estos pacientes [8], [28] (Figura 3). La posición prono homogeniza la distribución de la presión transpulmonar, y mejora la relación v/Q al favorecer la ventilación de los segmentos dorsales, siendo ampliamente usada y con buenos resultados durante esta pandemia [29]- [32] Así como el BNM, hemos adquirido evidencia empírica de su seguridad durante períodos prolongados, si bien requiere un adecuado entrenamiento del personal. Las dudas quedan con respecto al momento de su suspensión, ya que muchos pacientes presentan una evolución prolongada de varias semanas.…”

“…La neumonía CoviD-19 grave tiene un curso prolongado. varios reportes y nuestra experiencia muestran que el tiempo promedio en el ventilador es superior a las dos semanas [29], [32], [60]. vale decir, son pacientes críticos crónicos, con debilidad muscular, problemas nutricionales y cognitivos, e inmunodeficientes, expuestos a complicaciones infecciosas, trombóticas y hemorrágicas.…”