Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan.
Crit Care. 2022 May 6;26(1):124. doi: 10.1186/s13054-022-03995-1.
Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation.
A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation.
Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission.
Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.
一些学术组织建议，在 COVID-19 患者中，尤其是在大流行的早期阶段，以较低的氧气使用阈值进行插管。我们旨在阐明在需要插管的新型冠状病毒病 2019（COVID-19）患者中，早期插管是否与住院死亡率降低有关。
这是一项在日本 66 家医院进行的多中心、回顾性、观察性研究，研究对象为 2020 年 1 月至 9 月期间因中度至重度 COVID-19 而入院的患者。纳入标准为通过逆转录聚合酶链反应检测阳性诊断为 COVID-19 且入院时需要插管的患者。早期插管的定义为在≤6 L/min 的氧气使用情况下进行插管。比较早期插管和非早期插管患者的住院死亡率。采用倾向评分逆概率加权分析调整患者人口统计学、合并症、入院时的血流动力学状态和插管时间、插管前的药物、COVID-19 的严重程度和机构特征。基于年龄、插管时低氧血症的严重程度和从入院到插管的天数进行亚组分析。
在 412 名符合研究条件的患者中，有 110 名患者进行了早期插管。早期插管患者的住院死亡率低于非早期插管患者（18 [16.4%] 比 88 [29.1%]；比值比，0.48 [95%置信区间 0.27-0.84]；p=0.009，校正比值比，0.28 [95%置信区间 0.19-0.42]；p<0.001）。无论插管时的年龄和低氧血症严重程度如何，早期插管均有获益效果；然而，仅在入院后 2 天以上进行插管的患者中，早期插管与降低住院死亡率相关。
在≤6 L/min 的氧气使用情况下进行早期插管与 COVID-19 患者的住院死亡率降低相关，这些患者需要插管。
试验注册 None。
