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

Question: We evaluated whether the time between frst 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. Pat...

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Detalhes bibliográficos
Autores: González, Jessica, Benítez, Iván D., Gonzalo-Calvo, David de, Torres, Gerard, Batlle, Jordi de, Gómez, Silvia, Moncusí Moix, Anna, Carmona, Paola, Santisteve, Sally, Monge, Aida, Gort Paniello, Clara, Zuil, María, Cabo Gambín, Ramón, Manzano, Senra, Carlos, Vengoechea Aragoncillo, José Javier, Vaca, Rafaela, Minguez, Olga, Aguilar Cabello, María, Ferrer Roca, Ricard, Ceccato, Adrian, Fernández Barat, Laia, Motos, Ana, Riera, Jordi, Menéndez, Rosario, García Gasulla, Dario, Peñuelas, Oscar, Labarca, Gonzalo, Caballero, Jesús, Barberà, Carme, Torres Martí, Antoni, Barbé, Ferran, CIBERESUCICOVID Project (COV20/00110, ISCIII)
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/186115
Acesso em linha:https://hdl.handle.net/2445/186115
Access Level:acceso abierto
Palavra-chave:COVID-19
Síndrome del destret respiratori de l'adult
Malalts en estat crític
Intubació
Malalties del pulmó
Adult respiratory distress syndrome
Critically ill
Intubation
Pulmonary diseases
Descrição
Resumo:Question: We evaluated whether the time between frst 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 classifed as early intubation if they were intubated within the frst 48 h from the frst 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 signifcant 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 diference of −10.77 (95% CI −18.40 to −3.15), with a greater number of afected 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 frst respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up. Keywords: COVID-19, ARDS, Critically ill patients, Early intubation, Respiratory management, Pulmonary sequelae

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