Early intubation tied to better survival in COVID-19 patients with ARDS

Late intubation compounds the risk of death among coronavirus disease 2019 (COVID-19) patients on mechanical intubation due to respiratory insufficiency, a recent study has found.

Researchers conducted a prospective, observational, single-centre analysis of 183 consecutive COVID-19 patients wild moderate-to-severe acute respiratory distress syndrome (ARDS). All participants had lab-confirmed SARS-CoV-2 infection, were admitted to the intensive care unit (ICU), and were connected to a mechanical ventilation machine. The primary outcome was ICU death.

Participants were divided into two according to the time to intubation. Eighty-eight (48 percent) were intubated early, in under 48 hours, while the remaining 92 (52 percent) took more than 48 hours. The former group tended to be younger and had higher scores on the sequential organ failure assessment.

Sixteen patients in the early intubation group died in the ICU over the study duration, as compared with 48 in the late intubation group (18 percent vs 43 percent). A similar trend was reported for 28-day mortality, but the difference reached only borderline significance (13 percent vs 22 percent; p=0.087). Median length of stay in the ICU (15 vs 23 days; p=0.003) and in the hospital (31 vs 36 days; p=0.0310) were significantly shorter in early intubation patients.

Multivariate logistic regression analysis confirmed that time to intubation was a significant and independent indicator of mortality (odds ratio, 1.01, 95 percent confidence interval, 1.00–1.01; p=0.02).

“Further studies are required to confirm our findings and establish the best time for intubation in COVID-19 patients admitted with moderate-to-severe ARDS, the impact of adjuvant therapies, and the ventilatory approach,” the researchers said.