• Athanasios Chalkias, Yiyuan Huang, Anis Ismail, Ioannis Pantazopoulos, Nikolaos Papagiannakis, Brayden Bitterman, Elizabeth Anderson, Tonimarie Catalan, Grace K Erne, Caroline R Tilley, Abiola Alaka, Kingsley M Amadi, Feriel Presswalla, Pennelope Blakely, Enrique Bernal-Morell, Iria Cebreiros López, Jesper Eugen-Olsen, García de Guadiana RomualdoLuisLDepartment of Laboratory Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain., Evangelos J Giamarellos-Bourboulis, Sven H Loosen, Jochen Reiser, Frank Tacke, Anargyros Skoulakis, Eleni Laou, Mousumi Banerjee, Rodica Pop-Busui, Salim S Hayek, and International Study of Inflammation in COVID-19 (ISIC) Investigator Group.
• Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
• Crit. Care Med. 2024 Feb 23.

ObjectivesTo 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.DesignProspective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SettingTen academic institutions in the United States and Europe.PatientsAdults (≥ 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.InterventionsEarly invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 ratio less than or equal to 250.Measurements And Main ResultsThe 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).ConclusionsIn 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.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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