Comparison of clinical characteristics and outcomes of COVID-19 patients undergoing early versus late intubation from initial hospital admission: A systematic review and meta-analysis.
COVID-19
Delayed intubation
Early intubation
Late intubation
SARS-CoV-2
Journal
Respiratory investigation
ISSN: 2212-5353
Titre abrégé: Respir Investig
Pays: Netherlands
ID NLM: 101581124
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
15
07
2021
revised:
01
01
2022
accepted:
18
02
2022
pubmed:
4
4
2022
medline:
27
4
2022
entrez:
3
4
2022
Statut:
ppublish
Résumé
The true impact of intubation and mechanical ventilation in coronavirus disease 2019 (COVID-19) patients remains controversial. We searched Pubmed, Cochrane Library, Embase, and Web of Science databases from inception to October 30th, 2021 for studies containing comparative data of COVID-19 patients undergoing early versus late intubation from initial hospital admission. Early intubation was defined as intubation within 48 h of hospital admission. The primary outcomes assessed were all-cause in-hospital mortality, renal replacement therapy (RRT), and invasive mechanical ventilation (IMV) duration. Four cohort studies with 498 COVID-19 patients were included between February to August 2020, in which 28.6% had early intubation, and 36.0% underwent late intubation. Although the pooled hospital mortality rate was 32.1%, no significant difference in mortality rate was observed (odds ratio [OR] 0.81; 95% confidence interval 0.32-2.00; P = 0.64) among those undergoing early and late intubation. IMV duration (mean 9.62 vs. 11.77 days; P = 0.25) and RRT requirement (18.3% vs. 14.6%; OR 1.19; P = 0.59) were similar regardless of intubation timing. While age, sex, diabetes, and body mass index were comparable, patients undergoing early intubation had higher sequential organ failure assessment (SOFA) scores (mean 7.00 vs. 5.17; P < 0.001). The timing of intubation from initial hospital admission did not significantly alter clinical outcomes during the early phase of the COVID-19 pandemic. Higher SOFA scores could explain early intubation. With the advancements in COVID-19 therapies, more research is required to determine optimal intubation time beyond the first wave of the pandemic.
Sections du résumé
BACKGROUND
BACKGROUND
The true impact of intubation and mechanical ventilation in coronavirus disease 2019 (COVID-19) patients remains controversial.
METHODS
METHODS
We searched Pubmed, Cochrane Library, Embase, and Web of Science databases from inception to October 30th, 2021 for studies containing comparative data of COVID-19 patients undergoing early versus late intubation from initial hospital admission. Early intubation was defined as intubation within 48 h of hospital admission. The primary outcomes assessed were all-cause in-hospital mortality, renal replacement therapy (RRT), and invasive mechanical ventilation (IMV) duration.
RESULTS
RESULTS
Four cohort studies with 498 COVID-19 patients were included between February to August 2020, in which 28.6% had early intubation, and 36.0% underwent late intubation. Although the pooled hospital mortality rate was 32.1%, no significant difference in mortality rate was observed (odds ratio [OR] 0.81; 95% confidence interval 0.32-2.00; P = 0.64) among those undergoing early and late intubation. IMV duration (mean 9.62 vs. 11.77 days; P = 0.25) and RRT requirement (18.3% vs. 14.6%; OR 1.19; P = 0.59) were similar regardless of intubation timing. While age, sex, diabetes, and body mass index were comparable, patients undergoing early intubation had higher sequential organ failure assessment (SOFA) scores (mean 7.00 vs. 5.17; P < 0.001).
CONCLUSIONS
CONCLUSIONS
The timing of intubation from initial hospital admission did not significantly alter clinical outcomes during the early phase of the COVID-19 pandemic. Higher SOFA scores could explain early intubation. With the advancements in COVID-19 therapies, more research is required to determine optimal intubation time beyond the first wave of the pandemic.
Identifiants
pubmed: 35367154
pii: S2212-5345(22)00023-5
doi: 10.1016/j.resinv.2022.02.007
pmc: PMC8968211
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
327-336Informations de copyright
Copyright © 2022 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest The authors have no conflicts of interest.
Références
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Influenza Other Respir Viruses. 2019 Jul;13(4):382-390
pubmed: 30884185
Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620963017
pubmed: 33054630
Eur J Epidemiol. 2010 Sep;25(9):603-5
pubmed: 20652370
Clin Microbiol Infect. 2013 Mar;19(3):249-56
pubmed: 22404211
Crit Care Explor. 2020 Oct 23;2(10):e0262
pubmed: 33134950
Crit Care Med. 2016 Jan;44(1):120-9
pubmed: 26474112
Thromb Res. 2020 Nov;195:219-225
pubmed: 32777639
Medicine (Baltimore). 2020 Nov 20;99(47):e23315
pubmed: 33217868
J Allergy Clin Immunol. 2020 Jul;146(1):128-136.e4
pubmed: 32425269
JAMA Intern Med. 2020 Jul 1;180(7):934-943
pubmed: 32167524
Crit Care Med. 2020 Nov;48(11):e1045-e1053
pubmed: 32804790
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
N Engl J Med. 2021 Jan 7;384(1):20-30
pubmed: 33332779
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
Am J Respir Crit Care Med. 2020 May 15;201(10):1299-1300
pubmed: 32228035
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
Crit Care. 2021 Feb 11;25(1):58
pubmed: 33573680
Crit Care. 2021 Mar 25;25(1):121
pubmed: 33766109
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
Front Med (Lausanne). 2020 Dec 23;7:614152
pubmed: 33425957
Intensive Care Med. 2020 Jun;46(6):1099-1102
pubmed: 32291463
J Clin Med. 2020 Sep 02;9(9):
pubmed: 32887462
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
Chest. 2021 Feb;159(2):653-656
pubmed: 32882246
Lancet Respir Med. 2021 Feb;9(2):139-148
pubmed: 33169671
J Crit Care. 2021 Oct;65:164-169
pubmed: 34166852
Am J Respir Crit Care Med. 2017 Feb 15;195(4):438-442
pubmed: 27626833
Crit Care Explor. 2021 May 12;3(5):e0415
pubmed: 34079946
N Engl J Med. 2020 Nov 5;383(19):1813-1826
pubmed: 32445440
Am J Respir Crit Care Med. 2004 Jun 1;169(11):1198-202
pubmed: 14990393
JAMA. 2020 Jun 9;323(22):2329-2330
pubmed: 32329799