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Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients: A Single-Center Cohort Study
Journal article   Open access   Peer reviewed

Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients: A Single-Center Cohort Study

Alfonso C Hernandez-Romieu, Max W Adelman, Maxwell A Hockstein, Chad J Robichaux, Johnathan A Edwards, Jane C Fazio, James M Blum, Craig S Jabaley, Mark Caridi-Scheible, Greg S Martin, …
Critical care medicine, Vol.48(11), pp.e1045-e1053
11/2020
DOI: 10.1097/CCM.0000000000004600
PMCID: PMC7448713
PMID: 32804790
url
https://doi.org/10.1097/CCM.0000000000004600View
Published (Version of record) Open Access

Abstract

Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019. Retrospective cohort study. Six coronavirus disease 2019-specific ICUs across four university-affiliated hospitals in Atlanta, Georgia. Adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received high-flow nasal cannula or mechanical ventilation. None. Among 231 patients admitted to the ICU, 109 (47.2%) were treated with high-flow nasal cannula and 97 (42.0%) were intubated without preceding high-flow nasal cannula use. Of those managed with high-flow nasal cannula, 78 (71.6%) ultimately received mechanical ventilation. In total, 175 patients received mechanical ventilation; 44.6% were female, 66.3% were Black, and the median age was 66 years (interquartile range, 56-75 yr). Seventy-six patients (43.4%) were intubated within 8 hours of ICU admission, 57 (32.6%) between 8 and 24 hours of admission, and 42 (24.0%) greater than or equal to 24 hours after admission. Patients intubated within 8 hours were more likely to have diabetes, chronic comorbidities, and higher admission Sequential Organ Failure Assessment scores. Mortality did not differ by time to intubation (≤ 8 hr: 38.2%; 8-24 hr: 31.6%; ≥ 24 hr: 38.1%; p = 0.7), and there was no association between time to intubation and mortality in adjusted analysis. Similarly, there was no difference in initial static compliance, duration of mechanical ventilation, or ICU length of stay by timing of intubation. High-flow nasal cannula use prior to intubation was not associated with mortality. In this cohort of critically ill patients with coronavirus disease 2019, neither time from ICU admission to intubation nor high-flow nasal cannula use were associated with increased mortality. This study provides evidence that coronavirus disease 2019 respiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
 Intensive Care Units Pandemics Pneumonia, Viral - therapy Humans Middle Aged Male Respiratory Insufficiency - therapy Coronavirus Infections - mortality COVID-19 Cannula - adverse effects Cannula - statistics & numerical data Coronavirus Infections - therapy Pneumonia, Viral - complications Coronavirus Infections - complications Critical Illness - therapy Female Aged Intubation, Intratracheal - adverse effects Intubation, Intratracheal - statistics & numerical data Oxygen Inhalation Therapy - methods Pneumonia, Viral - mortality Retrospective Studies

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