Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

the International Study of Inflammation in COVID-19 (ISIC) Investigator Group

doi:10.1097/CCM.0000000000006229

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

the International Study of Inflammation in COVID-19 (ISIC) Investigator Group

Office of the President

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.

DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.

SETTING: Ten academic institutions in the United States and Europe.

PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.

INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pa o2 /F io2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pa o2 /F io2 ratio less than or equal to 250.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group ( p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).

CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

Original language	English (US)
Pages (from-to)	930-941
Number of pages	12
Journal	Critical care medicine
Volume	52
Issue number	6
DOIs	https://doi.org/10.1097/CCM.0000000000006229
State	Published - Jun 1 2024

Keywords

COVID-19
critical care
intubation
mechanical ventilation
mortality
outcome

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1097/CCM.0000000000006229

Cite this

@article{32c1774c79984ae89de2b8ffe18df8e7,

title = "Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study",

abstract = "OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SETTING: Ten academic institutions in the United States and Europe.PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pa o2 /F io2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pa o2 /F io2 ratio less than or equal to 250.MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group ( p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.",

keywords = "COVID-19, critical care, intubation, mechanical ventilation, mortality, outcome",

author = "{the International Study of Inflammation in COVID-19 (ISIC) Investigator Group} and Athanasios Chalkias and Yiyuan Huang and Anis Ismail and Ioannis Pantazopoulos and Nikolaos Papagiannakis and Brayden Bitterman and Elizabeth Anderson and Tonimarie Catalan and Erne, {Grace K.} and Tilley, {Caroline R.} and Abiola Alaka and Amadi, {Kingsley M.} and Feriel Presswalla and Pennelope Blakely and Enrique Bernal-Morell and {Cebreiros L{\'o}pez}, Iria and Jesper Eugen-Olsen and {de Guadiana Romualdo}, {Luis Garc{\'i}a} and Giamarellos-Bourboulis, {Evangelos J.} and Loosen, {Sven H.} and Jochen Reiser and Frank Tacke and Anargyros Skoulakis and Eleni Laou and Mousumi Banerjee and Rodica Pop-Busui and Hayek, {Salim S.} and Christopher Launius and Hanna Berlin and Azam, {Tariq U.} and Husam Shadid and Michael Pan and {O' Hayer}, Patrick and Chelsea Meloche and Rafey Feroze and Padalia, {Kishan J.} and Danny Perry and Abbas Bitar and Rayan Kaakati and Lili Zhao and Peiyao Zhao and Erinleigh Michaud and Ibrahim Khaleel and Annika Tekumulla and Medha Tripathi and Alexi Vasbinder and Alina Bardwell and Namratha Nelapudi and Jiazi Chen and Anis Ismail",

year = "2024",

month = jun,

day = "1",

doi = "10.1097/CCM.0000000000006229",

language = "English (US)",

volume = "52",

pages = "930--941",

journal = "Critical care medicine",

issn = "0090-3493",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

TY - JOUR

T1 - Intubation Decision Based on Illness Severity and Mortality in COVID-19

T2 - An International Study

AU - the International Study of Inflammation in COVID-19 (ISIC) Investigator Group

AU - Chalkias, Athanasios

AU - Huang, Yiyuan

AU - Ismail, Anis

AU - Pantazopoulos, Ioannis

AU - Papagiannakis, Nikolaos

AU - Bitterman, Brayden

AU - Anderson, Elizabeth

AU - Catalan, Tonimarie

AU - Erne, Grace K.

AU - Tilley, Caroline R.

AU - Alaka, Abiola

AU - Amadi, Kingsley M.

AU - Presswalla, Feriel

AU - Blakely, Pennelope

AU - Bernal-Morell, Enrique

AU - Cebreiros López, Iria

AU - Eugen-Olsen, Jesper

AU - de Guadiana Romualdo, Luis García

AU - Giamarellos-Bourboulis, Evangelos J.

AU - Loosen, Sven H.

AU - Reiser, Jochen

AU - Tacke, Frank

AU - Skoulakis, Anargyros

AU - Laou, Eleni

AU - Banerjee, Mousumi

AU - Pop-Busui, Rodica

AU - Hayek, Salim S.

AU - Launius, Christopher

AU - Berlin, Hanna

AU - Azam, Tariq U.

AU - Shadid, Husam

AU - Pan, Michael

AU - O' Hayer, Patrick

AU - Meloche, Chelsea

AU - Feroze, Rafey

AU - Padalia, Kishan J.

AU - Perry, Danny

AU - Bitar, Abbas

AU - Kaakati, Rayan

AU - Zhao, Lili

AU - Zhao, Peiyao

AU - Michaud, Erinleigh

AU - Khaleel, Ibrahim

AU - Tekumulla, Annika

AU - Tripathi, Medha

AU - Vasbinder, Alexi

AU - Bardwell, Alina

AU - Nelapudi, Namratha

AU - Chen, Jiazi

AU - Ismail, Anis

PY - 2024/6/1

Y1 - 2024/6/1

N2 - OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SETTING: Ten academic institutions in the United States and Europe.PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pa o2 /F io2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pa o2 /F io2 ratio less than or equal to 250.MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group ( p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

AB - OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SETTING: Ten academic institutions in the United States and Europe.PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pa o2 /F io2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pa o2 /F io2 ratio less than or equal to 250.MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group ( p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

KW - COVID-19

KW - critical care

KW - intubation

KW - mechanical ventilation

KW - mortality

KW - outcome

UR - http://www.scopus.com/inward/record.url?scp=85193458323&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85193458323&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000006229

DO - 10.1097/CCM.0000000000006229

M3 - Article

C2 - 38391282

AN - SCOPUS:85193458323

SN - 0090-3493

VL - 52

SP - 930

EP - 941

JO - Critical care medicine

JF - Critical care medicine

IS - 6

ER -

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this