학술논문
Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019
Document Type
article
Author
Ryo Yamamoto; Daiki Kaito; Koichiro Homma; Akira Endo; Takashi Tagami; Morio Suzuki; Naoyuki Umetani; Masayuki Yagi; Eisaku Nashiki; Tomohiro Suhara; Hiromasa Nagata; Hiroki Kabata; Koichi Fukunaga; Kazuma Yamakawa; Mineji Hayakawa; Takayuki Ogura; Atsushi Hirayama; Hideo Yasunaga; Junichi Sasaki; the J-RECOVER study group
Source
Critical Care, Vol 26, Iss 1, Pp 1-10 (2022)
Subject
Language
English
ISSN
1364-8535
Abstract
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