Mortality of intubated patients with COVID-19 during first and subsequent waves: a meta-analysis involving 363,660 patients from 43 countries

Xourgia, Eleni; Katsaros, Dimitrios Eleftherios; Xixi, Nikoleta A.; Tsolaki, Vasiliki; Routsi, Christina; Zakynthinos, Spyros; Κοτανίδου, Αναστασία; Siempos, Ilias I.

doi:10.1080/17476348.2022.2145950

Cited by 4 publications

(3 citation statements)

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“…Mortality in this subcohort of ISIC was 43.2%, also consistent with that reported in other cohorts of patients who are mechanically ventilated, ranging from 10% to 80% depending on period of the pandemic (3,26,44,45). Nevertheless, the risk of death among intubated patients with COVID-19 did not improve over time from the first to subsequent waves, independent of the geoeconomic variation (11), whereas the use of IMV decreased in some institutions (42), which makes the present study's findings relevant to both practitioners and policy-makers.…”

Section: Discussionmentioning

confidence: 58%

“…Considering that mortality of intubated patients with COVID-19 has not improved since the start of the pandemic (11), we hypothesized that an intubation strategy based on the severity of organ dysfunction may improve outcomes. In the present study, we evaluated the associations between the timing of intubation as defined by the severity of organ dysfunction and mortality in an international prospective cohort of patients hospitalized specifically for COVID- 19.…”

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confidence: 99%

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Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Chalkias,

Huang,

Ismail

et al. 2024

Critical Care Medicine

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Objectives: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices. Design: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022. Setting: Ten academic institutions in the United States and Europe. Patients: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test. Interventions: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao 2/Fio 2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao 2/Fio 2 ratio less than or equal to 250. Measurements and Main Results: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group (p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52–0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51–0.90; p = 0.006). Conclusions: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

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Section: Discussionmentioning

confidence: 58%

mentioning

confidence: 99%

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Chalkias,

Huang,

Ismail

et al. 2024

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Although we did not assess the effect of covid surge on mortality, significant differences among covid waves were not anticipated, as the mortality of intubated patients with COVID-19 has not improved over time from first to subsequent waves across several countries. 35 And finally, the analysis and results did not make an inference about changes within a subject across the study period. However, our results make clinical sense in that critically ill patients with COVID-19 who are sedated with etomidate do not often survive in the ICU.…”

Section: Discussionmentioning

confidence: 93%

Effects of Etomidate on Postintubation Hypotension, Inflammatory Markers, and Mortality in Critically Ill Patients with COVID-19: An International, Multicenter, Retrospective Study

Leou,

Mendez,

Horani

et al. 2023

J Intensive Care Med

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Objective To evaluate the association of etomidate with postintubation hypotension, inflammation, and mortality in critically ill patients with COVID-19. Design International, multicenter, retrospective study. Participants Critically ill patients hospitalized specifically for COVID-19 from three major academic institutions in the US and Europe. Main Outcome and Measures Patients were allocated into the etomidate (ET) group or another induction agent (OA) group. The primary outcome was postintubation hypotension. Secondary outcomes included postintubation inflammatory status, in-hospital mortality, and mortality at 30 days. Results 171 patients with a median age of 68 (IQR 58-73) years were included (ET, n = 98; OA, n = 73). Etomidate was associated with lower postintubation mean arterial pressure [74.33 (64-85) mm Hg versus 81.84 (69.75–94.25) mm Hg, p = 0.005] compared to other agents. No statistically significant differences were generally observed in inflammatory markers between the two groups at 7- and 14-days after admission to the intensive care unit. In-hospital mortality [77 (79%) versus 41 (56%), p = 0.003] and mortality at 30-days [78 (80%) versus 43 (59%), p = 0.006] were higher in the ET group. In multivariate logistic regression analysis, only etomidate (p = 0.009) and postintubation mean arterial pressure (p < 0.001) had a statistically significant effect on mortality, in contrast to stress-dose steroids (p = 0.301), after adjusting for creatinine (p = 0.695), blood urea nitrogen (p = 0.153), age (p = 0.055), oxygen saturation of hemoglobin (SpO2) (p = 0.941), and fraction of inspired oxygen (FiO2) (p = 0.712). Conclusions Administration of a single-bolus dose of etomidate in critically ill patients with COVID-19 is associated with lower postintubation mean arterial pressure and higher in-hospital and 30-day mortality compared to other induction agents.

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Clinical effectiveness of nirmatrelvir plus ritonavir in the treatment of COVID-19 in patients with cirrhosis

Hsu,

Shiau,

Liu

et al. 2023

Expert Review of Anti-infective Therapy

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Mortality of intubated patients with COVID-19 during first and subsequent waves: a meta-analysis involving 363,660 patients from 43 countries

Cited by 4 publications

References 46 publications

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Effects of Etomidate on Postintubation Hypotension, Inflammatory Markers, and Mortality in Critically Ill Patients with COVID-19: An International, Multicenter, Retrospective Study

Clinical effectiveness of nirmatrelvir plus ritonavir in the treatment of COVID-19 in patients with cirrhosis

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