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• W3205799372 abstract "TOPIC: Critical Care TYPE: Original Investigations PURPOSE: We aimed to determine the mortality risk associated with early intubation in patients with Acute Respiratory Distress syndrome due to COVID-19 infection. METHODS: A single-center retrospective cohort study. Data was collected for COVID-19 patients that required mechanical ventilation between March 1st to May 1st, 2020. Patients intubated for a reason other than respiratory failure or palliative extubation were excluded. All patients were discharged as either alive or deceased. Acute respiratory distress syndrome diagnosis was based on The Berlin Definition. Early intubation was defined as endotracheal intubation within ≤ 12 hours from admission. All medical decisions made by the Primary team and supported by clinical experience and guidelines generated for our institution during the COVID-19 pandemic. Non-rebreather mask, high-flow nasal cannula, and non-invasive ventilation were used as oxygen support therapy before endotracheal intubation. Binary logistic regression and Kaplan Meier analysis were conducted to determine an Odds Ratio for morality and survival rate. Cox proportional hazards regression was performed to determine the risk of mortality associated with Early intubation after adjustment for risk factors and confounders. Statistical significance was defined as p<0.05. RESULTS: 383 critical-ill patients required endotracheal intubation. 241 (63.0%) met the criteria for acute respiratory distress syndrome (ARDS) at admission and included in the analysis. Of them 127(53.0%) required endotracheal intubation within the first 12 hours following triage evaluation, and 114 (47.0%) after 12 hours. The overall mortality rate was 83.0%, being significantly higher in the early intubation group (88.2% vs. 77.2%, p=0.023. Patients in the late intubation group had a median time of survival of 13.6 (95% CI, 12.2-14.8) days, which was longer than the early intubation group 7.8 (95% CI, 7.1-8.6) days with a significant log-rank test. Moreover, unadjusted logistic regression showed that early intubation (2.21, CI 95%, 1.1-4.42, p=0.025) is a predictor of mortality. Cox proportional hazard analysis adjusted model for age, gender and BMI showed increased mortality risk in 63% (aHR=1.63,95% CI =1.22-2.17; p=0.001) and the model adjusted for risk factors and confounders showed increase in mortality risk in 54% (aHR=1.54, 95%CI=1.13-2.09; p=0.005). CONCLUSIONS: The highest mortality was reported at the beginning of the pandemic and gradually declined as the pandemic progressed as new data and approaches in management became available. The mortality rate was significantly higher in the early intubation group with an associated increased mortality risk of 54% after adjustment. We believe that in haste intubation for a patient developing compensatory physiologic changes during the initial phase of the disease COVID-19 can have a negative impact on mortality. The explanation for this demonstrated increase in mortality risk falls is likely multifactorial and may be due to the occurrence Ventilator-Induced Lung Injury, intra-hospital infection, ventilator-associated pneumonia, post-sepsis ICU syndrome as these are associated with prolonged ventilator use. CLINICAL IMPLICATIONS: Delaying intubation in patients with acute respiratory distress syndrome due to COVID-19 pneumonia when clinically feasible can may lessen overall mortality in this patient population. DISCLOSURES: No relevant relationships by Afsheen Afzal, source=Web Response No relevant relationships by Mohammad Aldiabat, source=Web Response No relevant relationships by Eze Amaechi, source=Web Response No relevant relationships by Sherida Edding, source=Web Response No relevant relationships by Sebastian Gandarillas Fraga, source=Web Response No relevant relationships by vidya menon, source=Web Response No relevant relationships by Sebastian Ocrospoma Heraud, source=Web Response No relevant relationships by Kennedy Omonuwa, source=Web Response No relevant relationships by Victor Perez Gutierrez, source=Web Response No relevant relationships by Mayer Rubin, source=Web Response" @default.
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• W3205799372 date "2021-10-01" @default.
• W3205799372 modified "2023-10-17" @default.
• W3205799372 title "ENDOTRACHEAL INTUBATION TIMING AND OUTCOME IN ARDS DUE TO COVID-19 INFECTION" @default.
• W3205799372 doi "https://doi.org/10.1016/j.chest.2021.07.946" @default.
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