Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Athanasios Chalkias; Yiyuan Huang; Anis Ismail; Ioannis Pantazopoulos; Nikolaos Papagiannakis; Brayden Bitterman; Elizabeth Anderson; Tonimarie Catalan; Grace K Erne; Caroline R Tilley; Abiola Alaka; Kingsley M Amadi; Feriel Presswalla; Pennelope Blakely; Enrique Bernal-Morell; Iria Cebreiros López; Jesper Eugen-Olsen; Luis García de Guadiana Romualdo; Evangelos J Giamarellos-Bourboulis; Sven H Loosen; Jochen Reiser; Frank Tacke; Anargyros Skoulakis; Eleni Laou; Mousumi Banerjee; Rodica Pop-Busui; Salim S Hayek; International Study of Inflammation in COVID-19 (ISIC) Investigator Group

doi:10.1097/CCM.0000000000006229

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

Athanasios Chalkias, Yiyuan Huang, Anis Ismail, Ioannis Pantazopoulos, Nikolaos Papagiannakis, Brayden Bitterman, Elizabeth Anderson, Tonimarie Catalan, Grace K Erne, Caroline R Tilley, Abiola Alaka, Kingsley M Amadi, Feriel Presswalla, Pennelope Blakely, Enrique Bernal-Morell, Iria Cebreiros López, Jesper Eugen-Olsen, Luis García de Guadiana Romualdo, Evangelos J Giamarellos-Bourboulis, Sven H LoosenJochen Reiser, Frank Tacke, Anargyros Skoulakis, Eleni Laou, Mousumi Banerjee, Rodica Pop-Busui, Salim S Hayek, International Study of Inflammation in COVID-19 (ISIC) Investigator Group

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Abstract

OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.

DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.

SETTING: Ten academic institutions in the United States and Europe.

PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.

INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 ratio less than or equal to 250.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group (p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).

CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

Originalsprog	Engelsk
Tidsskrift	Critical Care Medicine
Vol/bind	52
Udgave nummer	6
Sider (fra-til)	930-941
Antal sider	12
ISSN	0090-3493
DOI	https://doi.org/10.1097/CCM.0000000000006229
Status	Udgivet - 1 jun. 2024

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Chalkias, A., Huang, Y., Ismail, A., Pantazopoulos, I., Papagiannakis, N., Bitterman, B., Anderson, E., Catalan, T., Erne, G. K., Tilley, C. R., Alaka, A., Amadi, K. M., Presswalla, F., Blakely, P., Bernal-Morell, E., Cebreiros López, I., Eugen-Olsen, J., García de Guadiana Romualdo, L., Giamarellos-Bourboulis, E. J., ... International Study of Inflammation in COVID-19 (ISIC) Investigator Group (2024). Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study. Critical Care Medicine, 52(6), 930-941. https://doi.org/10.1097/CCM.0000000000006229

Chalkias, A, Huang, Y, Ismail, A, Pantazopoulos, I, Papagiannakis, N, Bitterman, B, Anderson, E, Catalan, T, Erne, GK, Tilley, CR, Alaka, A, Amadi, KM, Presswalla, F, Blakely, P, Bernal-Morell, E, Cebreiros López, I, Eugen-Olsen, J, García de Guadiana Romualdo, L, Giamarellos-Bourboulis, EJ, Loosen, SH, Reiser, J, Tacke, F, Skoulakis, A, Laou, E, Banerjee, M, Pop-Busui, R, Hayek, SS & International Study of Inflammation in COVID-19 (ISIC) Investigator Group 2024, 'Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study', Critical Care Medicine, bind 52, nr. 6, s. 930-941. https://doi.org/10.1097/CCM.0000000000006229

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title = "Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study",

abstract = "OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SETTING: Ten academic institutions in the United States and Europe.PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 ratio less than or equal to 250.MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group (p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.",

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author = "Athanasios Chalkias and Yiyuan Huang and Anis Ismail and Ioannis Pantazopoulos and Nikolaos Papagiannakis and Brayden Bitterman and Elizabeth Anderson and Tonimarie Catalan and Erne, {Grace K} and Tilley, {Caroline R} and Abiola Alaka and Amadi, {Kingsley M} and Feriel Presswalla and Pennelope Blakely and Enrique Bernal-Morell and {Cebreiros L{\'o}pez}, Iria and Jesper Eugen-Olsen and {Garc{\'i}a de Guadiana Romualdo}, Luis and Giamarellos-Bourboulis, {Evangelos J} and Loosen, {Sven H} and Jochen Reiser and Frank Tacke and Anargyros Skoulakis and Eleni Laou and Mousumi Banerjee and Rodica Pop-Busui and Hayek, {Salim S} and {International Study of Inflammation in COVID-19 (ISIC) Investigator Group}",

year = "2024",

month = jun,

day = "1",

doi = "10.1097/CCM.0000000000006229",

language = "English",

volume = "52",

pages = "930--941",

journal = "Critical Care Medicine",

issn = "0090-3493",

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TY - JOUR

T1 - Intubation Decision Based on Illness Severity and Mortality in COVID-19

T2 - An International Study

AU - Chalkias, Athanasios

AU - Huang, Yiyuan

AU - Ismail, Anis

AU - Pantazopoulos, Ioannis

AU - Papagiannakis, Nikolaos

AU - Bitterman, Brayden

AU - Anderson, Elizabeth

AU - Catalan, Tonimarie

AU - Erne, Grace K

AU - Tilley, Caroline R

AU - Alaka, Abiola

AU - Amadi, Kingsley M

AU - Presswalla, Feriel

AU - Blakely, Pennelope

AU - Bernal-Morell, Enrique

AU - Cebreiros López, Iria

AU - Eugen-Olsen, Jesper

AU - García de Guadiana Romualdo, Luis

AU - Giamarellos-Bourboulis, Evangelos J

AU - Loosen, Sven H

AU - Reiser, Jochen

AU - Tacke, Frank

AU - Skoulakis, Anargyros

AU - Laou, Eleni

AU - Banerjee, Mousumi

AU - Pop-Busui, Rodica

AU - Hayek, Salim S

AU - International Study of Inflammation in COVID-19 (ISIC) Investigator Group

PY - 2024/6/1

Y1 - 2024/6/1

N2 - OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SETTING: Ten academic institutions in the United States and Europe.PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 ratio less than or equal to 250.MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group (p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

AB - OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices.DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022.SETTING: Ten academic institutions in the United States and Europe.PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test.INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pao2/Fio2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pao2/Fio2 ratio less than or equal to 250.MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group (p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006).CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

KW - Aged

KW - COVID-19/mortality

KW - Critical Illness/mortality

KW - Europe/epidemiology

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Intubation, Intratracheal/statistics & numerical data

KW - Male

KW - Middle Aged

KW - Organ Dysfunction Scores

KW - Prospective Studies

KW - Respiration, Artificial/statistics & numerical data

KW - SARS-CoV-2

KW - Severity of Illness Index

KW - United States/epidemiology

KW - mechanical ventilation

KW - critical care

KW - intubation

KW - COVID-19

KW - mortality

KW - outcome

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U2 - 10.1097/CCM.0000000000006229

DO - 10.1097/CCM.0000000000006229

M3 - Journal article

C2 - 38391282

SN - 0090-3493

VL - 52

SP - 930

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JO - Critical Care Medicine

JF - Critical Care Medicine

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ER -

Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study

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