Abstract
Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005–1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).
Highlights
Patients with severe COVID-19 present with dyspnea and hypoxemia [1]
We evaluated all 592 patients with Severe Acute Respiratory Syndrome caused by SARS-CoV-2 virus who were submitted to EIT and mechanical ventilation (MV) in our institution (Figure 1)
Healthcare 2022, 9, x caused by SARS-CoV-2 virus who were submitted to EIT and MV in our institution (Figure 1)
Summary
A portion of these patients may develop Acute Respiratory Distress Syndrome (ARDS), which is defined as the acute onset of bilateral infiltrates, severe hypoxemia, and lung edema that is not fully explained by cardiac failure or fluid overload [2] Therapeutic strategies for these patients require respiratory support, ranging from supplementary oxygen through nasal cannula, non-rebreather mask, high-flow nasal oxygen cannula (HFNO), and non-invasive ventilation (NIV) to endotracheal intubation (ETI), invasive mechanical ventilation (MV), and extracorporeal membrane oxygenation (ECMO) [3,4,5]. The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Trial registration: The study protocol was approved by the local
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