Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019
Ryo Yamamoto,
Daiki Kaito,
Koichiro Homma,
Akira Endo,
Takashi Tagami,
Morio Suzuki,
Naoyuki Umetani,
Masayuki Yagi,
Eisaku Nashiki,
Tomohiro Suhara,
Hiromasa Nagata,
Hiroki Kabata,
Koichi Fukunaga,
Kazuma Yamakawa,
Mineji Hayakawa,
Takayuki Ogura,
Atsushi Hirayama,
Hideo Yasunaga,
Junichi Sasaki,
the J-RECOVER study group
Affiliations
Ryo Yamamoto
Department of Emergency and Critical Care Medicine, Keio University School of Medicine
Daiki Kaito
Department of Emergency and Critical Care Medicine, Keio University School of Medicine
Koichiro Homma
Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital
Akira Endo
Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital
Takashi Tagami
Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital
Morio Suzuki
Department of Emergency and Critical Care Medicine, Kawakita General Hospital
Naoyuki Umetani
Department of Emergency and Critical Care Medicine, Kawakita General Hospital
Masayuki Yagi
Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital
Eisaku Nashiki
Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital
Tomohiro Suhara
Department of Anesthesiology, Keio University School of Medicine
Hiromasa Nagata
Department of Anesthesiology, Keio University School of Medicine
Hiroki Kabata
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
Koichi Fukunaga
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
Kazuma Yamakawa
Department of Emergency Medicine, Osaka Medical and Pharmaceutical University
Mineji Hayakawa
Department of Emergency Medicine, Hokkaido University Hospital
Takayuki Ogura
Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital
Atsushi Hirayama
Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
Hideo Yasunaga
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
Junichi Sasaki
Department of Emergency and Critical Care Medicine, Keio University School of Medicine
Abstract Background Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation. Methods A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation. Results Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27–0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19–0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission. Conclusions Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.
