Timing of invasive mechanic ventilation in critically ill patients with coronavirus disease 2019

Link to article at PubMed

J Trauma Acute Care Surg. 2020 Sep 9. doi: 10.1097/TA.0000000000002939. Online ahead of print.


Invasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving IMV in Wuhan and to discuss the timing of IMV in these patients.

METHODS: Data of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020 were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge.

RESULTS: Among 40 COVID-19 patients with IMV, 31 died, 9 survived and discharged. The median age was 70 years (IQR 62-76), and non-survivors were older than survivors. The median period from the non-invasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR 2-42) in IMV survivors and 54 hours (IQR 28-143) in IMV non-survivors. We observed that when the time interval from NIV/HFNC to intubation less than 50 hours (about 2 calendar days), together with APACHE II score less than 10, or PSI score less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation as well as high levels of APACHE II and PSI prior to intubation was associated with higher mortality in critically ill patients. Multiple organ damage was common among these non-survivors in the course of treatment.

CONCLUSION: Early initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI score might help physicians in decision-making about timing of intubation for curbing subsequent mortality.

LEVEL OF EVIDENCE: level Vtherapeutic.

PMID:32925581 | DOI:10.1097/TA.0000000000002939

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