@misc{10498/29725,
year = {2023},
month = {3},
url = {http://hdl.handle.net/10498/29725},
abstract = {Background The primary aim of our study was to investigate the association between intubation timing
and hospital mortality in critically ill patients with coronavirus disease 2019 (COVID-19)-associated
respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic
waves and the influence of prior noninvasive respiratory support on outcomes.
Methods This is a secondary analysis of a multicentre, observational and prospective cohort study that
included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across
58 Spanish intensive care units (ICUs) participating in the CIBERESUCICOVID project. The study period
was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within
the first 24 h of ICU admission. Propensity score matching was used to achieve a balance across baseline
variables between the early intubation cohort and those patients who were intubated after the first 24 h of
ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We
performed sensitivity analyses to consider a different time-point (48 h from ICU admission) for early and
delayed intubation.
Results Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients
were included in the analysis (307 for each group). In the unmatched population, there were no differences
in mortality between the early and delayed groups. After propensity score matching, patients with delayed
intubation presented higher hospital mortality (27.3% versus 37.1%; p=0.01), ICU mortality (25.7% versus
36.1%; p=0.007) and 90-day mortality (30.9% versus 40.2%; p=0.02) compared with the early intubation
group. Very similar findings were observed when we used a 48-h time-point for early or delayed
intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and
45% in the first, second, third and fourth waves, respectively; first versus second, third and fourth waves
p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving
high-flow nasal cannula (HFNC) (n=294) who were intubated earlier. The subgroup of patients undergoing
noninvasive ventilation (n=214) before intubation showed higher mortality when delayed intubation was
set as that occurring after 48 h from ICU admission, but not when after 24 h.
Conclusions In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was
associated with a higher risk of hospital mortality. The use of early intubation significantly decreased
throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients
who had received HFNC.},
publisher = {European Respiratory Society},
keywords = {COVID-19},
keywords = {Intensive Care Units},
keywords = {Intubation},
keywords = {Intratracheal},
keywords = {Noninvasive Ventilation},
keywords = {Pandemics},
keywords = {Prospective Studies},
keywords = {Respiratory Insufficiency},
title = {Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic: a matched analysis},
doi = {10.1183/13993003.01426-2022},
author = {Riera, Jordi and Barbeta, Enric and Tormos, Adrián and Mellado Artigas, Ricard and Ceccato, Adrián and Motos, Anna and Fernández Barat, Laia and Ferrer, Ricard and García Gasulla, Dario and Peñuelas, Oscar and Lorente, José Ángel and Menéndez, Rosario and Roca, Oriol and Palomeque, Andrea and Ferrando, Carlos and Solé Violán, Jordi and Novo, Mariana and Boado, María Victoria and Tamayo, Luis and Estella García, Ángel and Galban, Cristóbal and Trenado, Josep and Huerta, Arturo and Loza, Ana and Aguilera, Luciano and García Garmendia, José Luís and Barberà, Carme and Gumucio, Víctor and Socias, Lorenzo and Franco, Nieves and Valdivia, Luis Jorge and Vidal, Pablo and Sagredo, Víctor and Ruiz García, Ángela Leonor and Martínez Varela, Ignacio and López, Juan and Pozo, Juan Carlos and Nieto, Maite and Gómez, José M. and Blandino, Aaron and Valledor, Manuel and Bustamante Munguira, Elena and Sánchez Miralles, Ángel and Peñasco, Yhivian and Barberán, José and Ubeda, Alejandro and Amaya Villar, Rosario and Martín, María Cruz and Jorge, Ruth and Caballero, Jesús and Marin, Judith and Añón, José Manuel and Suárez Sipmann, Fernando and Albaiceta, Guillermo M. and Castellanos Ortega, Álvaro and Adell Serrano, Berta and Catalán, Mercedes and Martínez de la Gándara, Amalia and Ricart, Pilar and Carbajales, Cristina and Rodríguez, Alejandro and Díaz, Emili and de la Torre, Mari C. and Gallego, Elena and Cantón-Bulnes, Luisa and Carbonell, Nieves and González, Jessica and de Gonzalo Calvo, David and Barbé, Ferrán and Torres, Antoni},
}