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

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2022Author
González, Jessica
de Gonzalo Calvo, David
Torres, Gerard
Batlle Garcia, Jordi de
Gómez Falguera, Silvia
Moncusí Moix, Anna
Carmona, Paola
Santisteve, Sally
Monge Esqué, Aida
Gort Paniello, Clara
Zuil, María
Cabo Gambín, Ramón
Manzano Senra, Carlos
Vengoechea Aragoncillo, José Javier
Vaca, Rafaela
Minguez Roure, Olga
Aguilar, María
Ferrer, Ricard
Ceccato, Adrián
Fernández Barat, Laia
Motos, Anna
Riera, Jordi
Menéndez, Rosario
García Gasulla, Dario
Peñuelas, Oscar
Labarca Trucios, Gonzalo
Caballero, Jesús
Barberà, Carme
Torres, Antoni
Suggested citation
González, Jessica;
Benítez, Iván;
de Gonzalo Calvo, David;
Torres, Gerard;
Batlle Garcia, Jordi de;
Gómez Falguera, Silvia;
...
Barbé Illa, Ferran.
(2022)
.
Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study.
Critical Care, 2022, vol. 16, núm. 1.
https://doi.org/10.1186/s13054-021-03882-1.
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Question: We 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 methods: Prospective 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.
Results: We 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.
Conclusions: Among 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.
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Critical Care, 2022, vol. 16, núm. 1European research projects
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