Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

Divisão de Pneumologia, Instituto Do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil

The Center for Emergencies in Public Health, Salvador 40301-155, Brazil

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Instituto Do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil

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Corporative IT, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil

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Data Office, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil

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Institute of Mathematics and Statistics, Universidade de São Paulo, São Paulo 05403-000, Brazil

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Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

^‡

HCFMUSP COVID-19 Study Group: Tarcisio E.P. Barros-Filho, Eloisa Bonfa, Edivaldo M. Utiyama, Aluisio C. Segurado, Beatriz Perondi, Anna Miethke-Morais, Amanda C. Montal, Leila Harima, Solange R.G. Fusco, Marjorie F. Silva, Marcelo C. Rocha, Izabel Marcilio, Izabel Cristina Rios, Fabiane Yumi Ogihara Kawano, Maria Amélia de Jesus, Esper Kallas, Maria Cristina Peres Braido Francisco, Carolina Mendes do Carmo, Clarice Tanaka, Maura Salaroli Oliveira, Thaís Guimarães, Carolina dos Santos Lázari, Marcello M.C. Magri, Rodrigo Antonio Brandão Neto, Anna Sara Shafferman Levin, Alberto José da Silva Duarte, Ester Sabino.

Academic Editor: Luigi Vetrugno

Healthcare 2022, 10(2), 206; https://doi.org/10.3390/healthcare10020206

Received: 12 December 2021 / Revised: 2 January 2022 / Accepted: 5 January 2022 / Published: 21 January 2022

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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Abstract

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005–1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068). View Full-Text

Keywords: SARS-CoV-2; COVID-19; intubation; emergency medicine

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MDPI and ACS Style

de Alencar, J.C.G.; Sternlicht, J.M.; Veiga, A.D.M.; Marchini, J.F.M.; Ferreira, J.C.; de Carvalho, C.R.R.; Marcilio, I.; da Silva, K.R.; Cobello Junior, V.; Felix, M.C.; Gomez, L.M.G.; de Souza, H.P.; Mauá, D.D.; Emergency USP COVID Group; HCFMUSP COVID-19 Study Group. Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow? Healthcare 2022, 10, 206. https://doi.org/10.3390/healthcare10020206

AMA Style

de Alencar JCG, Sternlicht JM, Veiga ADM, Marchini JFM, Ferreira JC, de Carvalho CRR, Marcilio I, da Silva KR, Cobello Junior V, Felix MC, Gomez LMG, de Souza HP, Mauá DD, Emergency USP COVID Group, HCFMUSP COVID-19 Study Group. Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow? Healthcare. 2022; 10(2):206. https://doi.org/10.3390/healthcare10020206

Chicago/Turabian Style

de Alencar, Júlio César Garcia, Juliana Martes Sternlicht, Alicia Dudy Muller Veiga, Julio Flávio Meirelles Marchini, Juliana Carvalho Ferreira, Carlos Roberto Ribeiro de Carvalho, Izabel Marcilio, Katia Regina da Silva, Vilson Cobello Junior, Marcelo Consorti Felix, Luz Marina Gomez Gomez, Heraldo Possolo de Souza, Denis Deratani Mauá, Emergency USP COVID Group, and HCFMUSP COVID-19 Study Group. 2022. "Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?" Healthcare 10, no. 2: 206. https://doi.org/10.3390/healthcare10020206

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