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

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 wer...

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Detalhes bibliográficos
Autores: González Gutiérrez, Jessica, Benítez Iglesias, Iván D., de Gonzalo Calvo, David, Torres Cortada, Gerard, Batlle, Jordi de, Gómez Falguera, Silvia, Moncusí Moix, Anna, Carmona, Paola, Santisteve, Sallya, Gort Paniello, Clara, Ferrer Roca, Ricard, Garcia Gasulla, Dario|||0000-0001-6732-5641, Torres, Antoni, Barbé, Ferran, Monge Esqué, Aida, Zuil Moreno, María
Formato: artículo
Fecha de publicación:2022
País:España
Recursos:Universitat Politècnica de Catalunya (UPC)
Repositorio:UPCommons. Portal del coneixement obert de la UPC
Idioma:inglés
OAI Identifier:oai:upcommons.upc.edu:2117/366399
Acesso em linha:https://hdl.handle.net/2117/366399
https://dx.doi.org/10.1186/s13054-021-03882-1
Access Level:acceso abierto
Palavra-chave:COVID-19 (Disease)
COVID-19
Mortality
Intubation
COVID-19 (Malaltia)
Àrees temàtiques de la UPC::Ciències de la salut::Medicina
Descrição
Resumo: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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