tetano
Editor, Senior Moderator
Crit Care Med
. 2024 Feb 23.
doi: 10.1097/CCM.0000000000006229. Online ahead of print. Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study
Athanasios Chalkias[SUP] 1 2 [/SUP], Yiyuan Huang[SUP] 3 [/SUP], Anis Ismail[SUP] 4 [/SUP], Ioannis Pantazopoulos[SUP] 5 [/SUP], Nikolaos Papagiannakis[SUP] 5 [/SUP], Brayden Bitterman[SUP] 4 [/SUP], Elizabeth Anderson[SUP] 4 [/SUP], Tonimarie Catalan[SUP] 4 [/SUP], Grace K Erne[SUP] 4 [/SUP], Caroline R Tilley[SUP] 4 [/SUP], Abiola Alaka[SUP] 4 [/SUP], Kingsley M Amadi[SUP] 4 [/SUP], Feriel Presswalla[SUP] 4 [/SUP], Pennelope Blakely[SUP] 4 [/SUP], Enrique Bernal-Morell[SUP] 6 [/SUP], Iria Cebreiros López[SUP] 7 [/SUP], Jesper Eugen-Olsen[SUP] 8 [/SUP], Luis García de Guadiana Romualdo[SUP] 9 [/SUP], Evangelos J Giamarellos-Bourboulis[SUP] 10 [/SUP], Sven H Loosen[SUP] 11 [/SUP], Jochen Reiser[SUP] 12 [/SUP], Frank Tacke[SUP] 13 [/SUP], Anargyros Skoulakis[SUP] 5 [/SUP], Eleni Laou[SUP] 5 [/SUP], Mousumi Banerjee[SUP] 3 [/SUP], Rodica Pop-Busui[SUP] 14 [/SUP], Salim S Hayek[SUP] 4 [/SUP]; International Study of Inflammation in COVID-19 (ISIC) Investigator Group
Collaborators, Affiliations
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
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.
. 2024 Feb 23.
doi: 10.1097/CCM.0000000000006229. Online ahead of print. Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study
Athanasios Chalkias[SUP] 1 2 [/SUP], Yiyuan Huang[SUP] 3 [/SUP], Anis Ismail[SUP] 4 [/SUP], Ioannis Pantazopoulos[SUP] 5 [/SUP], Nikolaos Papagiannakis[SUP] 5 [/SUP], Brayden Bitterman[SUP] 4 [/SUP], Elizabeth Anderson[SUP] 4 [/SUP], Tonimarie Catalan[SUP] 4 [/SUP], Grace K Erne[SUP] 4 [/SUP], Caroline R Tilley[SUP] 4 [/SUP], Abiola Alaka[SUP] 4 [/SUP], Kingsley M Amadi[SUP] 4 [/SUP], Feriel Presswalla[SUP] 4 [/SUP], Pennelope Blakely[SUP] 4 [/SUP], Enrique Bernal-Morell[SUP] 6 [/SUP], Iria Cebreiros López[SUP] 7 [/SUP], Jesper Eugen-Olsen[SUP] 8 [/SUP], Luis García de Guadiana Romualdo[SUP] 9 [/SUP], Evangelos J Giamarellos-Bourboulis[SUP] 10 [/SUP], Sven H Loosen[SUP] 11 [/SUP], Jochen Reiser[SUP] 12 [/SUP], Frank Tacke[SUP] 13 [/SUP], Anargyros Skoulakis[SUP] 5 [/SUP], Eleni Laou[SUP] 5 [/SUP], Mousumi Banerjee[SUP] 3 [/SUP], Rodica Pop-Busui[SUP] 14 [/SUP], Salim S Hayek[SUP] 4 [/SUP]; International Study of Inflammation in COVID-19 (ISIC) Investigator Group
Collaborators, Affiliations
- PMID: 38391282
- DOI: 10.1097/CCM.0000000000006229
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
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.