Intubation Decision Based on Illness Severity and Mortality in COVID-19 : An International Study
Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved..
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 Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Critical care medicine - (2024) vom: 23. Feb. |
| Sprache: |
Englisch |
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| Anmerkungen: |
Date Revised 23.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1097/CCM.0000000000006229 |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Chalkias, Athanasios |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intubation Decision Based on Illness Severity and Mortality in COVID-19 |b An International Study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 23.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022 | ||
| 520 | |a SETTING: Ten academic institutions in the United States and Europe | ||
| 520 | |a 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 | ||
| 520 | |a INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 ratio less than or equal to 250 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Papagiannakis, Nikolaos |e verfasserin |4 aut | |
| 700 | 1 | |a Bitterman, Brayden |e verfasserin |4 aut | |
| 700 | 1 | |a Anderson, Elizabeth |e verfasserin |4 aut | |
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| 700 | 1 | |a Erne, Grace K |e verfasserin |4 aut | |
| 700 | 1 | |a Tilley, Caroline R |e verfasserin |4 aut | |
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| 700 | 1 | |a Amadi, Kingsley M |e verfasserin |4 aut | |
| 700 | 1 | |a Presswalla, Feriel |e verfasserin |4 aut | |
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| 700 | 1 | |a García de Guadiana Romualdo, Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Giamarellos-Bourboulis, Evangelos J |e verfasserin |4 aut | |
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