Article, 2024

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Critical Care Medicine, ISSN 0090-3493, 1530-0293, Volume 52, 6, Pages 930-941, 10.1097/CCM.0000000000006229

Contributors

Chalkias A. 0000-0002-7634-4665 (Corresponding author) [1] [2] Huang Y. [3] Ismail A. [4] Pantazopoulos I. 0000-0002-8846-519X [5] Papagiannakis N. [5] Bitterman B. [4] Anderson E. [4] Catalan T. [4] Erne G.K. [4] Tilley C.R. [4] Alaka A. [4] Amadi K.-M. [4] Presswalla F. [4] Blakely P. [4] Bernal E. 0000-0002-4041-0579 [6] Cebreiros Lopez I. [7] Eugen-Olsen J. 0000-0002-4630-4275 [8] De Guadiana Romualdo L.G. 0000-0003-3028-3198 [9] Giamarellos-Bourboulis E.J. 0000-0003-4713-3911 [10] Loosen S.H. [11] Reiser J. [12] Tacke F. 0000-0001-6206-0226 [13] Skoulakis A. [5] Laou E. 0000-0002-4113-3083 [5] Banerjee M. [3] Pop-Busui R. 0000-0002-2042-1350 [4] Hayek S.S. [4] Launius C. [14] Berlin H. [14] Azam T.U. [14] Shadid H. [14] Pan M. [14] O' Hayer P. [14] Meloche C. [14] Feroze R. [14] Padalia K. [14] Perry D. [14] Bitar A. [14] Kaakati R. [14] Zhao L. [14] Zhao P. [14] Michaud E. [14] Khaleel I. [14] Tekumulla A. [14] Tripathi M. [14] Vasbinder A. [14] Bardwell A. [14] Nelapudi N. [14] Chen J. [14] Mayette N. [14] Sulaiman N. [14] Ismail A. [14] Pizzo I. [14] Bitterman B. [14] Reiser J. [15] Samelko B. [15] Hlepas A. [15] Wang X. [15] Patel P. [15] Pantazopoulos I. [5] Laou E. 0000-0002-4113-3083 [5] Skoulakis A. [5] Papagiannakis N. 0000-0002-8401-8472 [5] Eugen-Olsen J. [8] Altintas I. 0000-0001-6790-2218 [8] Tingleff J. [8] Stauning M.A. 0000-0002-5027-4435 [8] Houlind M.B. 0000-0003-4058-3012 [8] Lindstroem M.B. [8] Andersen O. 0000-0002-2274-548X [8] Gamst-Jensen H. 0000-0002-9537-0551 [8] Rasmussen L.J.H. 0000-0001-6613-2469 [8] Rasmussen C. [8] Nehlin J.O. 0000-0001-6038-5027 [8] Kallemose T. 0000-0002-7356-6481 [8] Parvaiz I. [8] Loosen S.H. [11] Luedde T. 0000-0002-6288-8821 [11] Keitel V. [11] Giamarellos-Bourboulis E.J. 0000-0003-4713-3911 [16] Adami M.-E. [16] Solomonidi N. [16] Tsilika M. [16] Saridaki M. [16] Lekakis V. [16] Tacke F. [13] Tober-Lau P. [13] Mohr R. 0000-0003-2403-4275 [13] Kurth F. [13] Sander L.E. 0000-0002-0476-9947 [13] Jochum C. [13] De Guadiana Romualdo L.G. 0000-0003-3028-3198 [17] Albaladejo-Oton M.D. [17] Dolores Rodriguez Mulero M. [17] Galindo Martinez M. [17] Hernandez Olivo M. [17] Campos Rodriguez V. [17] Cebreiros Lopez I. [7] Arnaldos Carrillo M. [7] Antonio Noguera Velasco J. [7] Pascual Figal D.A. [7] Bernal E. 0000-0002-4041-0579 [6] Alcaraz Garcia A. [6] Jose Alcaraz Garcia M. [6] Martinez Martinez M. [6] Esteban-Torrella P. [6] Sancho-Rodriguez N. [6]

Affiliations

  1. [1] Outcomes Research Consortium
    2. [NORA names: United States; America, North; OECD];
  2. [2] University of Pennsylvania
    3. [NORA names: United States; America, North; OECD];
  3. [3] University of Michigan
    4. [NORA names: United States; America, North; OECD];
  4. [4] University of Michigan Medical School
    5. [NORA names: United States; America, North; OECD];
  5. [5] University of Thessaly
    6. [NORA names: Greece; Europe, EU; OECD];

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 Pao/Fio ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao/Fio 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.

Keywords

COVID-19, critical care, intubation, mechanical ventilation, mortality, outcome

Funders

  • University of Michigan Medical School Central Biorepository
  • Michigan Clinical Research Unit

Data Provider: Elsevier

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