Dafang Chen, MD,
University of Southern California
Los Angeles, California
Disclosure information not submitted.
Ghazal Kabbach, M.D.
Physician
University of Southern California, United States
Disclosure information not submitted.
Moses Koo, M.D.
Physician
University of Southern California, United States
Disclosure information not submitted.
John Rodman, MPH
Biostatistician
University of Southern California, United States
Disclosure information not submitted.
Keith Killu, M.D.
Physician
University of Southern California, United States
Disclosure information not submitted.
Title: Time of Intubation for COVID-19 Patients and its Effect on Outcome
Introduction: Coronavirus disease 2019 (COVID-19) infections caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV2) virus can lead to severe respiratory failure requiring intubation and mechanical ventilation. The goal of our study was to determine whether early intubation using specific criteria can help decrease morbidity and mortality.
Methods: This was a retrospective study including adult patients in the ICU, who were infected with COVID-19 causing respiratory failure, requiring intubation and mechanical ventilation. All patients were on high flow nasal cannula (HFNC) prior to intubation. A COVID-19 respiratory score (CRS) was created using a modified respiratory failure risk index for intubation. The score was calculated using the following parameters: 1) Respiratory rate, 2) Oxygen saturation, 3) Fraction of inspired oxygen, 4) Number of liters per minute of oxygen and, 5) Number of hours on high flow nasal cannula prior to intubation. All variables were graded from 1-4 depending on the severity, and the score ranged from a minimum of 4 to a maximum of 20. Regression modeling was used to determine the association of early vs late intubation depending on the number of hours on HFNC and the CRS. Fisher’s Exact test was used to test for an association between time on HFNC and 30-day mortality.
Results: 76 patients were included in this study. 31 patients were in the early intubation group with a CRS < 14 and 45 patients were in the late intubation group with a CRS ≥14. The average age was 57.7 vs 57.1 years (p=0.85), average BMI was 30.3 vs 32.5 Kg/m2 (p=0.1), average P:F ratio was 99 vs 103 (p=0.68), and the sequential organ failure assessment (SOFA) scores was 6 vs 2 in the early vs late intubation groups, respectively (P < 0.02). Patients in the early intubation arm (CRS < 14) had shorter ICU length of stay (18 vs 28 days; p = 0.002), shorter hospital length of stay (22 vs 31 days; P = 0.02), and shorter time on the ventilator (17 vs 22 days; P = 0.048). Patients with CRS < 14 (mean of 8.7 hours on HFNC) was associated with 29% mortality vs 62% mortality (mean of 111.9 hours on HFNC) for patients with CRS ≥14 (p=0.004).
Conclusion: In patients infected with COVID-19 who developed respiratory failure and needed mechanical ventilation, intubating earlier may have better outcomes.