Time to intubation, ventilatory mechanics and outcome in COVID-19 patients with acute respiratory distress syndrome: A single-centre study.

Abstract

Background: We investigated the impact of time to intubation and the ventilatory mechanics on clinical outcomes in patients with COVID-19. Methods: We conducted an observational cohort study. Time to intubation was defined based on the patient’s hospital admission as early (≤2 days) or late (>2 days). In a secondary analysis, patients were further divided into three groups: intubated early (≤3 days), late (4-6 days), and very late (>6 days). Results: We included 194 consecutively intubated patients; 66.5% were male, and the median age was 65 years old. From them, 58 (29.9%) were intubated early and 136 (70.1%) late. Compared to patients intubated late, patients intubated early had lower mortality (44.8% vs 72%, p < 0.001), were younger (60 vs 67, p = 0.002), had lower sequential organ failure assessment (SOFA) scores (6 vs 8, p=0.002) and higher lung compliance on admission days 1, 6 and 12 (42 vs 36, p = 0.006; 40 vs 33, p < 0.001; and 37.5 vs 32, p < 0.001, respectively). Older age (aOR = 1.15, p < 0.001), time to intubation (aOR = 1.15, p = 0.004), high SOFA scores (aOR = 1.81, p < 0.001), a lower PaO2/FiO2 ratio (aOR = 0.96, p = 0.001), low lung compliance on admission Day 1 and 12 (aOR = 1.12, p = 0.012 and aOR = 1.14, p < 0.001, respectively), and a high white blood cell (WBC) number at admission (aOR = 1, p = 0.001) were associated with higher mortality. In the secondary analysis, very late and late intubated patients had higher mortality rates than patients intubated early (78.4% vs 63.4% vs 44.6%, respectively, p < 0.001). Conclusions: Among COVID-19 intubated patients, age, late intubation, high SOFA scores, high WBC, low PaO2/FiO2 ratio, and low lung compliance are associated with higher ICU mortality.