Farhadi Newsha, Varpaei Hesam Aldin, Fattah Ghazi Samrand, Amoozadeh Laya, Mohammadi Mostafa
Tehran University of Medical Sciences, Tehran, Iran.
Department of Nursing and Midwifery, Islamic Azad University Tehran Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2022 Jun 21;12(3):e123350. doi: 10.5812/aapm-123350. eCollection 2022 Jun.
The SARS-CoV-2 pandemic is one of the most significant challenges for healthcare providers, particularly in the critical care setting. The timing of intubation in COVID-19 patients seems to be challenging. Therefore, we aimed to investigate how it may have a survival benefit, and we determined which clinical characteristics were associated with outcomes.
This cross-sectional study was conducted in the Imam Khomeini Hospital Complex. We randomly selected patients admitted to intensive care units and, based on intubation status, categorized them into three subgroups (early, late, and not intubated). Early intubation is defined as intubation within 48 hours of ICU admission, and late intubation is defined as intubation after 48 hours of ICU admission.
Early-intubated patients were more likely to have dyspnea than late-intubated patients, and late-intubated patients had a higher mean heart rate than early-intubated patients. The neutrophil/lymphocyte ratio was significantly (P < 0.05) lower in not-intubated patients than in other patients. There was no difference in NLR between early- and late-intubated patients. Mean serum creatine phosphokinase and troponin I levels were higher in late-intubated patients than in early- and not-intubated patients. Early-intubated patients had a lower ROX index than late-intubated patients. Patients with higher scores of APACHE 2, respiratory rates, and neutrophil to lymphocyte ratio were more likely to be intubated. Increasing APACHE and SOFA scores were associated with decreased odds of survival.
There were no statistically significant differences in total mortality between early- and late-intubated patients. APACHE 2 scores, NLR, RR, and history of ischemic heart disease are some of the appropriate predictors of intubation. Higher respiratory rates (tachypnea) can be an indicator of early intubation. The ROX index is one of the most sensitive and capable tools for predicting intubation. Intubation status is a potent predictor of in-hospital mortality.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行是医疗服务提供者面临的最重大挑战之一，尤其是在重症监护环境中。新型冠状病毒肺炎（COVID-19）患者的插管时机似乎具有挑战性。因此，我们旨在研究其如何带来生存益处，并确定哪些临床特征与预后相关。
这项横断面研究在伊玛目霍梅尼医院综合院区进行。我们随机选择入住重症监护病房的患者，并根据插管状态将他们分为三个亚组（早期、晚期和未插管）。早期插管定义为在入住重症监护病房48小时内插管，晚期插管定义为在入住重症监护病房48小时后插管。
早期插管患者比晚期插管患者更易出现呼吸困难，晚期插管患者的平均心率高于早期插管患者。未插管患者的中性粒细胞/淋巴细胞比值显著低于其他患者（P<0.05）。早期和晚期插管患者之间的中性粒细胞与淋巴细胞比值（NLR）没有差异。晚期插管患者的平均血清肌酸磷酸激酶和肌钙蛋白I水平高于早期和未插管患者。早期插管患者的ROX指数低于晚期插管患者。急性生理学与慢性健康状况评分系统Ⅱ（APACHE 2）评分、呼吸频率和中性粒细胞与淋巴细胞比值较高的患者更有可能接受插管。急性生理学与慢性健康状况评分系统（APACHE）和序贯器官衰竭评估（SOFA）评分增加与生存几率降低相关。
早期和晚期插管患者的总死亡率在统计学上没有显著差异。APACHE 2评分、NLR、呼吸频率和缺血性心脏病史是插管的一些合适预测指标。较高的呼吸频率（呼吸急促）可能是早期插管的一个指标。ROX指数是预测插管最敏感且有效的工具之一。插管状态是住院死亡率的一个有力预测指标。
