• Qian Zhang, Jun Shen, Liangkai Chen, Sumeng Li, Wenkai Zhang, Cheng Jiang, Haoli Ma, Lian Lin, Xin Zheng, and Yan Zhao.
• From the Department of Infectious Diseases (Q.Z., S.L., X.Z.), Union Hospital, Tongji Medical College, and Joint International Laboratory of Infection and Immunity (Q.Z., S.L., X.Z.), Huazhong University of Science and Technology; Department of Nutrition and Food Hygiene (L.C.), Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; Emergency Center (J.S., C.J., H.M., L.L., Y.Z.), Zhongnan Hospital of Wuhan University; and Intensive Care Unit (W.Z.), Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• J Trauma Acute Care Surg. 2020 Dec 1; 89 (6): 1092-1098.

BackgroundInvasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving IMV in Wuhan and to discuss the timing of IMV in these patients.MethodsData of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020, were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge.ResultsAmong 40 COVID-19 patients with IMV, 31 died, and 9 survived and was discharged. The median age was 70 years (interquartile range [IQR], 62-76 years), and nonsurvivors were older than survivors. The median period from the noninvasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR, 2-42 hours) in IMV survivors and 54 hours (IQR, 28-143 hours) in IMV nonsurvivors. We observed that, when the time interval from NIV/HFNC to intubation was less than 50 hours (about 2 calendar days), together with Acute Physiology and Chronic Health Evaluation II (APACHE II) score of less than 10 or pneumonia severity index (PSI) score of less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation and high levels of APACHE II and PSI before intubation were associated with higher mortality in critically ill patients. Multiple organ damage was common among these nonsurvivors in the course of treatment.ConclusionEarly initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI scores might help physicians in decision making about timing of intubation for curbing subsequent mortality.Level Of EvidenceTherapeutic, level V.

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