Chong Woon Hean, Saha Biplab K, Murphy Dermot J, Chopra Amit
Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, New York, 12208, USA.
Department of Pulmonary and Critical Care, Ozarks Medical Center, 1100 Kentucky Ave, West Plains, Missouri, 65775, USA.
Respir Investig. 2022 May;60(3):327-336. doi: 10.1016/j.resinv.2022.02.007. Epub 2022 Mar 31.
The true impact of intubation and mechanical ventilation in coronavirus disease 2019 (COVID-19) patients remains controversial.
We searched Pubmed, Cochrane Library, Embase, and Web of Science databases from inception to October 30th, 2021 for studies containing comparative data of COVID-19 patients undergoing early versus late intubation from initial hospital admission. Early intubation was defined as intubation within 48 h of hospital admission. The primary outcomes assessed were all-cause in-hospital mortality, renal replacement therapy (RRT), and invasive mechanical ventilation (IMV) duration.
Four cohort studies with 498 COVID-19 patients were included between February to August 2020, in which 28.6% had early intubation, and 36.0% underwent late intubation. Although the pooled hospital mortality rate was 32.1%, no significant difference in mortality rate was observed (odds ratio [OR] 0.81; 95% confidence interval 0.32-2.00; P = 0.64) among those undergoing early and late intubation. IMV duration (mean 9.62 vs. 11.77 days; P = 0.25) and RRT requirement (18.3% vs. 14.6%; OR 1.19; P = 0.59) were similar regardless of intubation timing. While age, sex, diabetes, and body mass index were comparable, patients undergoing early intubation had higher sequential organ failure assessment (SOFA) scores (mean 7.00 vs. 5.17; P < 0.001).
The timing of intubation from initial hospital admission did not significantly alter clinical outcomes during the early phase of the COVID-19 pandemic. Higher SOFA scores could explain early intubation. With the advancements in COVID-19 therapies, more research is required to determine optimal intubation time beyond the first wave of the pandemic.
气管插管和机械通气对2019冠状病毒病（COVID-19）患者的实际影响仍存在争议。
我们检索了从数据库建立至2021年10月30日的PubMed、Cochrane图书馆、Embase和科学网数据库，以查找包含COVID-19患者从首次入院起早期与晚期插管比较数据的研究。早期插管定义为入院后48小时内插管。评估的主要结局为全因院内死亡率、肾脏替代治疗（RRT）和有创机械通气（IMV）持续时间。
2020年2月至8月纳入了四项队列研究，共498例COVID-19患者，其中28.6%进行了早期插管，36.0%进行了晚期插管。尽管汇总的医院死亡率为32.1%，但早期和晚期插管患者的死亡率未观察到显著差异（比值比[OR]0.81；95%置信区间0.32 - 2.00；P = 0.64）。无论插管时机如何，IMV持续时间（平均9.62天对11.77天；P = 0.25）和RRT需求（18.3%对14.6%；OR 1.19；P = 0.59）相似。虽然年龄、性别、糖尿病和体重指数具有可比性，但早期插管患者的序贯器官衰竭评估（SOFA）评分更高（平均7.00对5.17；P < 0.001）。
在COVID-19大流行早期，从首次入院起的插管时机并未显著改变临床结局。较高的SOFA评分可以解释早期插管的原因。随着COVID-19治疗方法的进步，需要更多研究来确定大流行第一波之后的最佳插管时间。
