An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial).

Background and Aims: Prolonged high flow nasal oxygen (HFNO) application might delay intubation and increase mortality in acute hypoxemic respiratory failure (AHRF) patients. Intubation in coronavirus disease 2019 (COVID-19) AHRF (CAHRF) patients 24 to 48 hours after HFNO initiation has been associated with increased mortality in previous studies. This cut-off period is variable in previous studies. A time series analysis could reflect more robust data on outcome in relation to HFNO duration before intubation in CAHRF. Methods: A retrospective study was conducted at 30-bedded ICU of a tertiary care teaching hospital from July 2020 to August 2021. The study cohort comprised 116 patients who required HFNO and were subsequently intubated following HFNO failure. A time series analysis of patient outcomes on each day of HFNO application prior to invasive mechanical ventilation (IMV) was done. Results: ICU and hospital mortality was 67.2%. Beyond day 4 of HFNO application, there was a trend towards increased risk-adjusted ICU and hospital mortality for each day delay in intubation of CAHRF patients on HFNO [OR 2.718; 95% CI 0.957-7.721; P 0.061]. This trend was maintained till day 8 of HFNO application, after which there was 100% mortality. Taking day four as a cut-off in the timeline of HFNO application, we have observed an absolute mortality benefit of 15% with early intubation despite a higher APACHE-IV score than the late intubation group. Conclusion: IMV beyond the 4th day of HFNO initiation in CAHRF patients increases mortality.

An Observational Study on Patients With COVID-19 Infection Admitted to the Intensive Care Unit With Respect to Their Vaccination Status.

Background SARS-CoV-2 (COVID-19) created unprecedented recurrent waves of pandemic globally. Apart from COVID-19-appropriate behavior, vaccinating the population was proposed to be the most effective measure to control these outbreaks. However, the outcomes of vaccinated patients admitted to the intensive care unit (ICU) and their comparison with unvaccinated counterparts, especially in developing countries, have not been extensively studied. Materials and methods Our study examined consecutive patients with positive RT-PCR for COVID-19 admitted to the ICU from August 1, 2021, to July 31, 2022. Prior vaccination status and its relation to demographics, disease severity, mortality, and length of stay were analyzed. Results Among 436 patients admitted to the ICU, 76 (15.4%) were unvaccinated and 369 (84.6%) were vaccinated against COVID-19. Vaccinated patients were significantly older and hypertensive, and had comparatively less severity of illness than unvaccinated patients. Crude ICU and hospital mortality were significantly lower among vaccinated patients than unvaccinated patients (15.2% versus 25.4% and 16% versus 22.3%, respectively; P<0.05). Furthermore, risk-adjusted multivariate analysis demonstrated a strong but statistically nonsignificant inverse association between vaccination status and ICU mortality (odds ratio (OR)=0.540, 95% confidence interval (CI)=0.290-1.006, P=0.052). Conclusion In severe COVID-19-infected patients who required admission to the ICU, the majority were vaccinated. However, the severity of illness and hospital mortality was significantly lower among vaccinated patients with breakthrough infections.