Association between early intubation and mortality in patients at high risk for noninvasive ventilation failure: a propensity-matched cohort study.

BACKGROUND

Noninvasive ventilation (NIV) is frequently employed for acute hypoxemic respiratory failure, yet optimal intubation timing for high-risk NIV failure patients remains uncertain.

OBJECTIVES

To investigate mortality outcomes associated with early versus late intubation in high-risk NIV failure patients.

DESIGN

Secondary analysis of a multicenter observational cohort study.

METHODS

Patients with high NIV failure risk (updated HACOR score ⩾11 after 1-2 h of NIV) were enrolled. We defined that intubation was needed in these high-risk patients. Intubation occurring within 12 h of NIV initiation was classified as early intubation, while intubation after 12 h was designated as late intubation. Primary outcomes were intensive care unit (ICU) and hospital mortality. In sensitivity analyses, patients who achieved NIV success were categorized into the late-intubation group. Due to baseline imbalances, propensity score matching was performed with covariate adjustment.

RESULTS

Among the study population, 171 patients underwent early intubation and 222 underwent late intubation. Despite greater baseline severity in the early intubation group, ICU mortality (36% vs 58%,  < 0.001) and hospital mortality (38% vs 58%,  < 0.001) were significantly lower compared to the late-intubation group. In sensitivity analyses, 190 patients with NIV success were included in the late-intubation group, further accentuating the severity disparity between groups. After propensity matching (220 patients: 110 per group), most of the baseline characteristics were comparable. The early intubation group had a 100% intubation rate versus 71% in the late-intubation group, with the latter exhibiting higher mortality (ICU: 46% vs 32%,  = 0.052; hospital: 50% vs 34%,  = 0.020).

CONCLUSION

In patients at high risk for NIV failure, early intubation is associated with reduced mortality.