학술논문
Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study*
Document Type
Academic Journal
Author
Chalkias, Athanasios; Huang, Yiyuan; Ismail, Anis; Pantazopoulos, Ioannis; Papagiannakis, Nikolaos; Bitterman, Brayden; Anderson, Elizabeth; Catalan, Tonimarie; Erne, Grace K.; Tilley, Caroline R.; Alaka, Abiola; Amadi, Kingsley M.; Presswalla, Feriel; Blakely, Pennelope; Bernal-Morell, Enrique; Cebreiros López, Iria; Eugen-Olsen, Jesper; García de Guadiana Romualdo, Luis; Giamarellos-Bourboulis, Evangelos J.; Loosen, Sven H.; Reiser, Jochen; Tacke, Frank; Skoulakis, Anargyros; Laou, Eleni; Banerjee, Mousumi; Pop-Busui, Rodica; Hayek, Salim S.; Hayek, Salim S.; Blakely, Pennelope; Launius, Christopher; Berlin, Hanna; Amadi, Kingsley M.; Azam, Tariq U.; Shadid, Husam; Pan, Michael; O’ Hayer, Patrick; Meloche, Chelsea; Feroze, Rafey; Padalia, Kishan J.; Anderson, Elizabeth; Perry, Danny; Bitar, Abbas; Kaakati, Rayan; Zhao, Lili; Zhao, Peiyao; Michaud, Erinleigh; Huang, Yiyuan; Catalan, Tonimarie; Khaleel, Ibrahim; Alaka, Abiola; Pop-Busui, Rodica; Banerjee, Mousumi; Tekumulla, Annika; Tilley, Caroline R.; Tripathi, Medha; Vasbinder, Alexi; Bardwell, Alina; Presswalla, Feriel; Nelapudi, Namratha; Erne, Grace K.; Chen, Jiazi; Mayette, Nathan; Sulaiman, Noor; Ismail, Anis; Pizzo, Ian; Bitterman, Brayden; Reiser, Jochen; Samelko, Beata; Hlepas, Alexander; Wang, Xuexiang; Patel, Priya; Chalkias, Athanasios; Pantazopoulos, Ioannis; Laou, Eleni; Skoulakis, Anargyros; Papagiannakis, Nikolaos; Eugen-Olsen, Jesper; Altintas, Izzet; Tingleff, Jens; Stauning, Marius; Houlind, Morten Baltzer; Lindstrøm, Mette B; Andersen, Ove; Gamst-Jensen, Hejdi; Hartmann Rasmussen, Line Jee; Rasmussen, Christian; Nehlin, Jan O.; Kallemose, Thomas; Parvaiz, Imran; Loosen, Sven H.; Luedde, Tom; Keitel, Verena; Giamarellos-Bourboulis, Evangelos J.; Adami, Maria-Evangelia; Solomonidi, Nicky; Tsilika, Maria; Saridaki, Maria; Lekakis, Vasileios; Tacke, Frank; Tober-Lau, Pinkus; Mohr, Raphael; Kurth, Florian; Sander, Leif Erik; Jochum, Christoph; Garcia de Guadiana-Romualdo, Luis; Albaladejo-Otón, María Dolores; Rodríguez Mulero, María Dolores; Martínez, María Galindo; Olivo, Marta Hernández; Rodríguez, Valerio Campos; López, Iria Cebreiros; Carrillo, María Arnaldos; Noguera Velasco, Jose Antonio; Pascual Figal, Domingo A.; Morell, Enrique Bernal; García, Antonia Alcaraz; Alcaraz García, María José; Martínez, Monica Martínez; Esteban-Torrella, Patricia; Sancho-Rodríguez, Natalia
Source
Critical Care Medicine. Jun 01, 2024 52(6):930-941
Subject
Language
English
ISSN
0090-3493
Abstract
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.