tetano
Editor, Senior Moderator
Crit Care
. 2022 May 6;26(1):124.
doi: 10.1186/s13054-022-03995-1.
Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019
Ryo Yamamoto[SUP] 1 [/SUP], Daiki Kaito[SUP] 2 [/SUP], Koichiro Homma[SUP] 3 [/SUP], Akira Endo[SUP] 4 [/SUP], Takashi Tagami[SUP] 3 5 [/SUP], Morio Suzuki[SUP] 6 [/SUP], Naoyuki Umetani[SUP] 6 [/SUP], Masayuki Yagi[SUP] 7 [/SUP], Eisaku Nashiki[SUP] 8 [/SUP], Tomohiro Suhara[SUP] 9 [/SUP], Hiromasa Nagata[SUP] 9 [/SUP], Hiroki Kabata[SUP] 10 [/SUP], Koichi Fukunaga[SUP] 10 [/SUP], Kazuma Yamakawa[SUP] 11 [/SUP], Mineji Hayakawa[SUP] 12 [/SUP], Takayuki Ogura[SUP] 13 [/SUP], Atsushi Hirayama[SUP] 14 [/SUP], Hideo Yasunaga[SUP] 5 [/SUP], Junichi Sasaki[SUP] 2 [/SUP], J-RECOVER study group
Affiliations
Abstract
Background: Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation.
Methods: A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation.
Results: Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission.
Conclusions: Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.
Keywords: Coronavirus infection; Critical care; Oxygen; Pulmonary function; Respiratory failure; Timing of intubation.
. 2022 May 6;26(1):124.
doi: 10.1186/s13054-022-03995-1.
Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019
Ryo Yamamoto[SUP] 1 [/SUP], Daiki Kaito[SUP] 2 [/SUP], Koichiro Homma[SUP] 3 [/SUP], Akira Endo[SUP] 4 [/SUP], Takashi Tagami[SUP] 3 5 [/SUP], Morio Suzuki[SUP] 6 [/SUP], Naoyuki Umetani[SUP] 6 [/SUP], Masayuki Yagi[SUP] 7 [/SUP], Eisaku Nashiki[SUP] 8 [/SUP], Tomohiro Suhara[SUP] 9 [/SUP], Hiromasa Nagata[SUP] 9 [/SUP], Hiroki Kabata[SUP] 10 [/SUP], Koichi Fukunaga[SUP] 10 [/SUP], Kazuma Yamakawa[SUP] 11 [/SUP], Mineji Hayakawa[SUP] 12 [/SUP], Takayuki Ogura[SUP] 13 [/SUP], Atsushi Hirayama[SUP] 14 [/SUP], Hideo Yasunaga[SUP] 5 [/SUP], Junichi Sasaki[SUP] 2 [/SUP], J-RECOVER study group
Affiliations
- PMID: 35524282
- DOI: 10.1186/s13054-022-03995-1
Abstract
Background: Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation.
Methods: A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation.
Results: Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission.
Conclusions: Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.
Keywords: Coronavirus infection; Critical care; Oxygen; Pulmonary function; Respiratory failure; Timing of intubation.