Temple/St. Luke's Medical School, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA 18015, USA.
Department of Emergency Medicine, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.
Int J Environ Res Public Health. 2022 Mar 5;19(5):3075. doi: 10.3390/ijerph19053075.
Best practices for management of COVID-19 patients with acute respiratory failure continue to evolve. Initial debate existed over whether patients should be intubated in the emergency department or trialed on noninvasive methods prior to intubation outside the emergency department.
To determine whether emergency department intubations in COVID-19 affect mortality.
We conducted a retrospective observational chart review of patients who had a confirmed positive COVID-19 test and required endotracheal intubation during their hospital course between 1 March 2020 and 1 June 2020. Patients were divided into two groups based on location of intubation: early intubation in the emergency department or late intubation performed outside the emergency department. Clinical and demographic information was collected including comorbid medical conditions, qSOFA score, and patient mortality.
Of the 131 COVID-19-positive patients requiring intubation, 30 (22.9%) patients were intubated in the emergency department. No statistically significant difference existed in age, gender, ethnicity, or smoking status between the two groups at baseline. Patients in the early intubation cohort had a greater number of existing comorbidities (2.5, = 0.06) and a higher median qSOFA score (3, ≤ 0.001). Patients managed with early intubation had a statistically significant higher mortality rate (19/30, 63.3%) compared to the late intubation group (42/101, 41.6%).
COVID-19 patients intubated in the emergency department had a higher qSOFA score and a greater number of pre-existing comorbidities. All-cause mortality in COVID-19 was greater in patients intubated in the emergency department compared to patients intubated outside the emergency department.
管理 COVID-19 合并急性呼吸衰竭患者的最佳实践仍在不断发展。最初的争议在于患者是否应该在急诊科进行插管，还是应该在急诊科外进行非侵入性方法尝试后再插管。
确定 COVID-19 患者在急诊科进行插管是否会影响死亡率。
我们对 2020 年 3 月 1 日至 2020 年 6 月 1 日期间住院期间需要进行气管插管的 COVID-19 检测呈阳性并需要进行气管插管的患者进行了回顾性观察性图表回顾。根据插管的位置将患者分为两组：急诊科早期插管或急诊科外晚期插管。收集了临床和人口统计学信息，包括合并症、qSOFA 评分和患者死亡率。
在需要插管的 131 例 COVID-19 阳性患者中，有 30 例（22.9%）在急诊科进行插管。两组患者在基线时的年龄、性别、种族或吸烟状况无统计学差异。早期插管组患者存在更多的现有合并症（2.5， = 0.06）和更高的中位 qSOFA 评分（3， ≤ 0.001）。与晚期插管组（42/101，41.6%）相比，早期插管组患者的死亡率（19/30，63.3%）有统计学显著升高。
在急诊科插管的 COVID-19 患者的 qSOFA 评分更高，合并症更多。与在急诊科插管的患者相比，在急诊科外插管的 COVID-19 患者的全因死亡率更高。
