RT journal article
T1 Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic: a matched analysis
A1 Riera, Jordi
A1 Barbeta, Enric
A1 Tormos, Adrián
A1 Mellado Artigas, Ricard
A1 Ceccato, Adrián
A1 Motos, Anna
A1 Fernández Barat, Laia
A1 Ferrer, Ricard
A1 García Gasulla, Dario
A1 Peñuelas, Oscar
A1 Lorente, José Ángel
A1 Menéndez, Rosario
A1 Roca, Oriol
A1 Palomeque, Andrea
A1 Ferrando, Carlos
A1 Solé Violán, Jordi
A1 Novo, Mariana
A1 Boado, María Victoria
A1 Tamayo, Luis
A1 Estella García, Ángel
A1 Galban, Cristóbal
A1 Trenado, Josep
A1 Huerta, Arturo
A1 Loza, Ana
A1 Aguilera, Luciano
A1 García Garmendia, José Luís
A1 Barberà, Carme
A1 Gumucio, Víctor
A1 Socias, Lorenzo
A1 Franco, Nieves
A1 Valdivia, Luis Jorge
A1 Vidal, Pablo
A1 Sagredo, Víctor
A1 Ruiz García, Ángela Leonor
A1 Martínez Varela, Ignacio
A1 López, Juan
A1 Pozo, Juan Carlos
A1 Nieto, Maite
A1 Gómez, José M.
A1 Blandino, Aaron
A1 Valledor, Manuel
A1 Bustamante Munguira, Elena
A1 Sánchez Miralles, Ángel
A1 Peñasco, Yhivian
A1 Barberán, José
A1 Ubeda, Alejandro
A1 Amaya Villar, Rosario
A1 Martín, María Cruz
A1 Jorge, Ruth
A1 Caballero, Jesús
A1 Marin, Judith
A1 Añón, José Manuel
A1 Suárez Sipmann, Fernando
A1 Albaiceta, Guillermo M.
A1 Castellanos Ortega, Álvaro
A1 Adell Serrano, Berta
A1 Catalán, Mercedes
A1 Martínez de la Gándara, Amalia
A1 Ricart, Pilar
A1 Carbajales, Cristina
A1 Rodríguez, Alejandro
A1 Díaz, Emili
A1 de la Torre, Mari C.
A1 Gallego, Elena
A1 Cantón-Bulnes, Luisa
A1 Carbonell, Nieves
A1 González, Jessica
A1 de Gonzalo Calvo, David
A1 Barbé, Ferrán
A1 Torres, Antoni
A2 Medicina
K1 COVID-19
K1 Intensive Care Units
K1 Intubation
K1 Intratracheal
K1 Noninvasive Ventilation
K1 Pandemics
K1 Prospective Studies
K1 Respiratory Insufficiency
AB Background The primary aim of our study was to investigate the association between intubation timingand hospital mortality in critically ill patients with coronavirus disease 2019 (COVID-19)-associatedrespiratory failure. We also analysed both the impact of such timing throughout the first four pandemicwaves and the influence of prior noninvasive respiratory support on outcomes.Methods This is a secondary analysis of a multicentre, observational and prospective cohort study thatincluded all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across58 Spanish intensive care units (ICUs) participating in the CIBERESUCICOVID project. The study periodwas between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring withinthe first 24 h of ICU admission. Propensity score matching was used to achieve a balance across baselinevariables between the early intubation cohort and those patients who were intubated after the first 24 h ofICU admission. Differences in outcomes between early and delayed intubation were also assessed. Weperformed sensitivity analyses to consider a different time-point (48 h from ICU admission) for early anddelayed intubation.Results Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patientswere included in the analysis (307 for each group). In the unmatched population, there were no differencesin mortality between the early and delayed groups. After propensity score matching, patients with delayedintubation presented higher hospital mortality (27.3% versus 37.1%; p=0.01), ICU mortality (25.7% versus36.1%; p=0.007) and 90-day mortality (30.9% versus 40.2%; p=0.02) compared with the early intubationgroup. Very similar findings were observed when we used a 48-h time-point for early or delayedintubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and45% in the first, second, third and fourth waves, respectively; first versus second, third and fourth wavesp<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receivinghigh-flow nasal cannula (HFNC) (n=294) who were intubated earlier. The subgroup of patients undergoingnoninvasive ventilation (n=214) before intubation showed higher mortality when delayed intubation wasset 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 wasassociated with a higher risk of hospital mortality. The use of early intubation significantly decreasedthroughout the course of the pandemic. Benefits of such an approach occurred more notably in patientswho had received HFNC.
PB European Respiratory Society
SN 0903-1936
YR 2023
FD 2023-03-01
LK http://hdl.handle.net/10498/29725
UL http://hdl.handle.net/10498/29725
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 12-nov-2026