First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA.
J Crit Care. 2022 Oct;71:154062. doi: 10.1016/j.jcrc.2022.154062. Epub 2022 May 17.
Optimal timing of intubation is controversial. We attempted to investigate the association between timing of intubation and clinical outcomes of critically ill patients.
PubMed was systematically searched for studies reporting on mortality of critically ill patients undergoing early versus late intubation. Studies involving patients with new coronavirus disease (COVID-19) were excluded because a relevant meta-analysis has been published. "Early" intubation was defined according to the authors of the included studies. All-cause mortality was the primary outcome. Pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42021284850).
In total, 27 studies involving 15,441 intubated patients (11,943 early, 3498 late) were included. All-cause mortality was lower in patients undergoing early versus late intubation (7338 deaths; 45.8% versus 53.5%; RR 0.92, 95% CI 0.87-0.97; p = 0.001). This was also the case in the sensitivity analysis of studies defining "early" as intubation within 24 h from admission in the intensive care unit (6279 deaths; 45.8% versus 53.6%; RR 0.93, 95% CI 0.89-0.98; p = 0.005).
Avoiding late intubation may be associated with lower mortality in critically ill patients without COVID-19.
气管插管的最佳时机存在争议。我们试图研究气管插管时机与危重症患者临床结局之间的关系。
系统检索 PubMed 数据库，以查找报告危重症患者行早期与晚期气管插管死亡率的研究。由于已发表了相关的荟萃分析，因此排除了涉及新型冠状病毒病（COVID-19）患者的研究。“早期”气管插管根据纳入研究的作者定义。全因死亡率是主要结局。使用随机效应模型计算汇总风险比（RR）和 95%置信区间（CI）。该荟萃分析已在 PROSPERO（CRD42021284850）上注册。
共纳入 27 项研究，涉及 15441 例接受气管插管的患者（早期 11943 例，晚期 3498 例）。与晚期气管插管相比，早期气管插管患者的全因死亡率更低（7338 例死亡；45.8% 比 53.5%；RR 0.92，95%CI 0.87-0.97；p = 0.001）。在将“早期”定义为入住重症监护病房 24 h 内进行气管插管的研究的敏感性分析中也是如此（6279 例死亡；45.8% 比 53.6%；RR 0.93，95%CI 0.89-0.98；p = 0.005）。
对于没有 COVID-19 的危重症患者，避免晚期气管插管可能与死亡率降低相关。
