• Crit Care · Jan 2022

    Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study.

    • Jessica González, Iván D Benítez, David de Gonzalo-Calvo, Gerard Torres, Jordi de Batlle, Silvia Gómez, Anna Moncusí-Moix, Paola Carmona, Sally Santisteve, Aida Monge, Clara Gort-Paniello, María Zuil, Ramón Cabo-Gambín, Carlos Manzano Senra, José Javier Vengoechea Aragoncillo, Rafaela Vaca, Olga Minguez, María Aguilar, Ricard Ferrer, Adrián Ceccato, Laia Fernández, Ana Motos, Jordi Riera, Rosario Menéndez, Darío Garcia-Gasulla, Oscar Peñuelas, Gonzalo Labarca, Jesús Caballero, Carme Barberà, Antoni Torres, Ferran Barbé, and CIBERESUCICOVID Project (COV20/00110, ISCIII).
    • Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.
    • Crit Care. 2022 Jan 10; 26 (1): 1818.

    QuestionWe evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae.Materials And MethodsProspective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge.ResultsWe included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29-4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42-4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of - 10.77 (95% CI - 18.40 to - 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89-2.13]) and a greater TSS (+ 4.35 [95% CI 2.41-6.27]) in the chest CT scan.ConclusionsAmong critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.© 2022. The Author(s).

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