Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patient...

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Vydáno v:	Critical care (London, England) Ročník 25; číslo 1; s. 121 - 9
Hlavní autoři:	Papoutsi, Eleni, Giannakoulis, Vassilis G., Xourgia, Eleni, Routsi, Christina, Kotanidou, Anastasia, Siempos, Ilias I.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London BioMed Central 25.03.2021 BioMed Central Ltd Springer Nature B.V BMC
Témata:	Acute respiratory distress syndrome Acute respiratory failure Bias Care and treatment Clinical outcomes Cohort analysis Cohort Studies Coronavirus Coronaviruses COVID-19 COVID-19 - mortality COVID-19 - therapy Critical care Critical Care Medicine Critical Illness Critically ill Delayed Emergency Medicine Handbooks Humans Intensive Intensive care unit Intubation Intubation, Intratracheal - statistics & numerical data Length of stay Medical research Medicine Medicine & Public Health Medicine, Experimental Meta-analysis Mortality Patient outcomes Patients Pneumonia Renal replacement therapy Severe acute respiratory syndrome coronavirus 2 Systematic review Time Factors Trachea Treatment Outcome Ventilators United States Acute respiratory distress syndrome Acute respiratory failure Pneumonia Coronavirus Delayed Intensive care unit
ISSN:	1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Popis
Shrnutí:	Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.
Bibliografie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1364-8535 1466-609X 1364-8535 1466-609X 1366-609X
DOI:	10.1186/s13054-021-03540-6