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Effect of Early vs. Delayed or No Intubation on Clinical Outcomes of Patients With COVID-19: An Observational Study.
Siempos, Ilias I; Xourgia, Eleni; Ntaidou, Theodora K; Zervakis, Dimitris; Magira, Eleni E; Kotanidou, Anastasia; Routsi, Christina; Zakynthinos, Spyros G.
  • Siempos II; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Xourgia E; Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY, United States.
  • Ntaidou TK; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Zervakis D; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Magira EE; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Kotanidou A; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Routsi C; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Zakynthinos SG; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Front Med (Lausanne) ; 7: 614152, 2020.
Article in English | MEDLINE | ID: covidwho-1021896
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Invasive mechanical ventilation NOS TREATS Acute Hypoxemic Respiratory Failure
Subject
Invasive mechanical ventilation NOS
Predicate
TREATS
Object
Acute Hypoxemic Respiratory Failure
3. COVID-19 CAUSES Acute Hypoxemic Respiratory Failure
Subject
COVID-19
Predicate
CAUSES
Object
Acute Hypoxemic Respiratory Failure
4. Acute Hypoxemic Respiratory Failure PROCESS_OF Patients
Subject
Acute Hypoxemic Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
5. Invasive mechanical ventilation NOS TREATS Patients
Subject
Invasive mechanical ventilation NOS
Predicate
TREATS
Object
Patients
6. Hospitals LOCATION_OF Observational Study
Subject
Hospitals
Predicate
LOCATION_OF
Object
Observational Study
7. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
8. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
9. Invasive mechanical ventilation NOS TREATS Acute Hypoxemic Respiratory Failure
Subject
Invasive mechanical ventilation NOS
Predicate
TREATS
Object
Acute Hypoxemic Respiratory Failure
10. COVID-19 CAUSES Acute Hypoxemic Respiratory Failure
Subject
COVID-19
Predicate
CAUSES
Object
Acute Hypoxemic Respiratory Failure
11. Acute Hypoxemic Respiratory Failure PROCESS_OF Patients
Subject
Acute Hypoxemic Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
12. Invasive mechanical ventilation NOS TREATS Patients
Subject
Invasive mechanical ventilation NOS
Predicate
TREATS
Object
Patients
13. Hospitals LOCATION_OF Observational Study
Subject
Hospitals
Predicate
LOCATION_OF
Object
Observational Study
14. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

Background:

Optimal timing of initiation of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 is unknown. Thanks to early flattening of the epidemiological curve, ventilator demand in Greece was kept lower than supply throughout the pandemic, allowing for unbiased comparison of the outcomes of patients undergoing early intubation vs. delayed or no intubation.

Methods:

We conducted an observational study including all adult patients with laboratory-confirmed COVID-19 consecutively admitted in Evangelismos Hospital, Athens, Greece between March 11, 2020 and April 15, 2020. Patients subsequently admitted in the intensive care unit (ICU) were categorized into the "early intubation" vs. the "delayed or no intubation" group. The "delayed or no intubation" group included patients receiving non-rebreather mask for equal to or more than 24 h or high-flow nasal oxygen for any period of time or non-invasive mechanical ventilation for any period of time in an attempt to avoid intubation. The remaining intubated patients comprised the "early intubation" group.

Results:

During the study period, a total of 101 patients (37% female, median age 65 years) were admitted in the hospital. Fifty-nine patients (58% of the entire cohort) were exclusively hospitalized in general wards with a mortality of 3% and median length of stay of 7 days. Forty-two patients (19% female, median age 65 years) were admitted in the ICU; all with acute hypoxemic respiratory failure. Of those admitted in the ICU, 62% had at least one comorbidity and 14% were never intubated. Early intubation was not associated with higher ICU-mortality (21 vs. 33%), fewer ventilator-free days (3 vs. 2 days) or fewer ICU-free days than delayed or no intubation.

Conclusions:

A strategy of early intubation was not associated with worse clinical outcomes compared to delayed or no intubation. Given that early intubation may presumably reduce virus aerosolization, these results may justify further research with a randomized controlled trial.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Controlled clinical trial / Randomized controlled trials Language: English Journal: Front Med (Lausanne) Year: 2020 Document Type: Article Affiliation country: Fmed.2020.614152

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Controlled clinical trial / Randomized controlled trials Language: English Journal: Front Med (Lausanne) Year: 2020 Document Type: Article Affiliation country: Fmed.2020.614152