Lee, Yong Hoon; Choi, Keum-Ju; Choi, Sun Ha; Lee, Shin Yup; Kim, Kyung Chan; Kim, Eun Jin; Lee, Jaehee
Journal of clinical medicine
2020Sep ; 9 ( 9 ) :.
PMID : 32887462
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Lee, Yong Hoon - Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea.
Choi, Keum-Ju - Department of Internal Medicine, Daegu Veterans Hospital, Daegu 42835, Korea.
Choi, Sun Ha - Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,
Lee, Shin Yup - Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,
Kim, Kyung Chan - Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu
Kim, Eun Jin - Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu
Lee, Jaehee - Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,
ABSTRACT
The effect of intubation timing on the prognosis of critically ill patients with coronavirus 2019 (COVID-19) is not yet well understood. We investigated whether early intubation is associated with the survival of COVID-19 patients with acute respiratory distress syndrome (ARDS). This multicenter, retrospective, observational study was done on 47 adult COVID-19 patients with ARDS who were admitted to the intensive care unit (ICU) in Daegu, Korea between February 17 and April 23, 2020. Clinical characteristics and in-hospital mortality were compared between the early intubation and initially non-intubated groups, and between the early and late intubation groups, respectively. Of the 47 patients studied, 23 (48.9%) were intubated on the day of meeting ARDS criteria (early intubation), while 24 (51.1%) were not initially intubated. Eight patients were never intubated during the in-hospital course. Median follow-up duration was 46 days, and 21 patients (44.7%) died in the hospital. No significant difference in in-hospital mortality rate was noted between the early group and initially non-intubated groups (56.5% vs. 33.3%, p = 0.110). Furthermore, the risk of in-hospital death in the early intubation group was not significantly different compared to the initially non-intubated group on multivariate adjusted analysis (p = 0.385). Results were similar between early and late intubation in the subgroup analysis of 39 patients treated with mechanical ventilation. In conclusion, in this study of critically ill COVID-19 patients with ARDS, early intubation was not associated with improved survival. This result may help in the efficient allocation of limited medical resources, such as ventilators.
keyword
COVID-19; acute respiratory distress syndrome; intensive care units; intubation; mortality; respiratory failure
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