Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic : a matched analysis
Riera del Brio, Jordi (Hospital Universitari Vall d'Hebron)
Barbeta, Enric (Instituto de Salud Carlos III)
Tormos, Adrián (Barcelona Supercomputing Center)
Mellado-Artigas, Ricard (Hospital Clínic i Provincial de Barcelona)
Ceccato, Adrian (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Motos, Ana (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Fernández-Barat, Laia (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Ferrer, Ricard (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Garcia-Gasulla, Dario (Barcelona Supercomputing Center)
Peñuelas, Oscar (Hospital Universitario de Getafe (Madrid))
Lorente, José Ángel (Hospital Universitario de Getafe (Madrid))
Menéndez, Rosario (Hospital Universitari i Politècnic La Fe (València))
Roca, Oriol (Hospital Universitari Vall d'Hebron)
Palomeque, Andrea (Hospital Clínic i Provincial de Barcelona)
Ferrando, Carlos (Hospital Clínic i Provincial de Barcelona)
Solé Violan, Jordi (Hospital Universitario de Gran Canaria Dr. Negrín)
Novo, Mariana (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Boado Varela, Maria Victoria (Hospital Universitario de Cruces (Barakaldo, País Basc))
Tamayo, Luis (Hospital Universitario Río Hortega (Valladolid))
Estella, Ángel (Universidad de Cádiz. Departamento Medicina)
Galbán, Cristóbal (Complejo Hospitalario Universitario de Santiago de Compostela)
Trenado Álvarez, José (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Huerta, Arturo (Clínica Sagrada Familia (Barcelona, Catalunya))
Loza, Ana (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Aguilera, Luciano (Hospital de Basurto (Bilbao, Biscaia))
Garmendia, José Luís García (Hospital San Juan de Dios del Aljarafe)
Barberà, Carme (Hospital Santa Maria (Lleida))
Gumucio, Víctor (Institut d'Investigació Biomèdica de Bellvitge)
Socias, Lorenzo (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Franco, Nieves (Hospital Universitario de Móstoles (Madrid))
Valdivia, Luis Jorge (Barcelona Supercomputing Center)
Vidal-Cortés, Pablo (Complejo Hospitalario Universitario de Ourense)
Sagredo, Victor (Hospital Universitario de Salamanca)
Ruiz-García, Ángela Leonor (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Varela, Ignacio Martínez (Hospital Universitario Lucus Augusti (Lugo))
López, Juan (Complejo Asistencial Universitario de Palencia)
Pozo, Juan Carlos (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Nieto, Maite (Hospital Universitario de Segovia)
Gómez, José M (Hospital General Universitario Gregorio Marañón)
Blandino Ortiz, Aaron (Hospital Universitario Ramón y Cajal (Madrid))
Valledor, Manuel (Hospital Universitario San Agustín (Avilés))
Bustamante-Munguira, Elena (Hospital Clínico Universitario de Valladolid)
Sánchez-Miralles, Ángel (Hospital Universitario San Juan de Alicante)
Peñasco, Yhivian (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Barberán, José (Hospital Universitario HM Montepríncipe)
Ubeda, Alejandro (Hospital Punta de Europa)
Amaya-Villar, Rosario (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Martín, María Cruz (Hospital Universitario Torrejón)
Jorge García, Ruth Noemí (Hospital Nuestra Señora de Gracia)
Caballero, Jesús (Hospital Arnau de Vilanova (Lleida, Catalunya))
Marin, Judith (Institut Hospital del Mar d'Investigacions Mèdiques)
Añón, José Manuel (Hospital Universitario La Paz (Madrid))
Sipmann, Fernando Suárez (Intensive Care Unit, Hospital Universitario La Princesa (Madrid))
Muñiz, Guillermo (Instituto Universitario de Oncología del Principado de Asturias)
Castellanos-Ortega, Álvaro (Hospital Universitari i Politècnic La Fe (València))
Adell-Serrano, Berta (Hospital de Tortosa Verge de la Cinta)
Catalán, Mercedes (Hospital Universitario 12 de Octubre (Madrid))
de la Gándara, Amalia Martínez (Hospital Universitario Infanta Leonor)
Ricart, Pilar (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Carbajales, Cristina (Hospital Álvaro Cunqueiro (Vigo))
Rodríguez, Alejandro (Hospital Universitari Joan XXIII de Tarragona)
Díaz Santos, Emilio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
de la Torre, Maria del Carmen (Hospital de Mataró. Consorci Sanitari del Maresme)
Gallego, Elena (Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara (Extremadura))
Cantón-Bulnes, Luisa (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Carbonell, Nieves (Hospital Clínic Universitari (València))
González Gutiérrez, Jessica (Institut de Recerca Biomèdica de Lleida)
Gonzalo Calvo, David de (Institut de Recerca Biomèdica de Lleida)
Barbé, Ferran (Institut de Recerca Biomèdica de Lleida)
Torres, Antoni (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with COVID-19-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior non-invasive respiratory support on outcomes. This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICU) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of intensive care unit (ICU) admission. Propensity score (PS) matching was used to achieve balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different timepoint (48 h from ICU admission) for early and delayed intubation. Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After PS matching, patients with delayed intubation presented higher hospital mortality (27. 3% versus 37. 1%, p =0. 01), ICU mortality (25. 7% versus 36. 1%, p=0. 007) and 90-day mortality (30. 9% versus 40. 2%, p=0. 02) when compared to the early intubation group. Very similar findings were observed when we used a 48-hour timepoint for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth wave, respectively; first versus second, third and fourth waves p<0. 001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (n=294) who were intubated earlier. The subgroup of patients undergoing NIV (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received high-flow nasal cannula.
Ayudas:	Instituto de Salud Carlos III COV20/00110 Instituto de Salud Carlos III CP20/00041
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	European respiratory journal, november 2022, ISSN 1399-3003

DOI: 10.1183/13993003.01426-2022
PMID: 36396142

64 p, 1.3 MB

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