In patients who are hospitalized with severe COVID-19, delayed intensive care unit (ICU) admission and subsequent intubation might prove potentially harmful and has been associated with increased mortality, according to the results of a recent study published in the journal Anaesthesia Critical Care & Pain Medicine.

A prospective, observational, single-center study on the topic was conducted in the ICU of Geneva University Hospitals in Switzerland between March 9, 2020, and January 9, 2021. All adult patients who were admitted to the ICU with acute respiratory failure due to COVID-19 and required intubation were included in the study.

Study investigators grouped patients according to the time period in which they were admitted to the ICU. Patients admitted to the ICU between March 9, 2020, and May 15, 2020 were defined as being in the “first wave” of COVID-19; patients defined as being in the “second wave” were admitted to the ICU between May 16, 2020, and January 9, 2021. The primary study outcome was ICU mortality.


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A total of 223 patients were intubated during the study period — 124 of them during the first COVID-19 wave and 99 during the second wave. The researchers found that  participants in the second wave were admitted to the ICU significantly later during their  hospital stay than participants in the first wave (median, 4 days [range, 1 to 7 days] vs 2 days [range, 0 to 4 days], respectively; P <.01).

Additionally, patients who were admitted to the ICU during the second COVID-19 wave were more severely ill compared with those admitted during the first wave (median Acute Physiology and Chronic Health Evaluation [APACHE] II score, 26 [range, 18 to 30] vs 22 [range, 14 to 29], respectively; P <.01 and median Simplified Acute Physiology Score [SAPS] II score, 60 [range, 43 to 72] vs 52.5 [range, 40.5 to 65], respectively;
P <.01).

Further, all-cause ICU mortality was significantly higher during the second COVID-19 wave than during the first wave (42% vs 23%, respectively; P <.01). Per multivariate analysis, the delay between hospital admission and intubation was significantly associated with morality in the ICU (odds ratio, 3.25; 95% CI, 1.38-7.67; P <.05).

Limitations of the current study include the fact that it used a single-center design, which thus limits generalizability of the results. Additionally, only those individuals who ultimately required an intubation were included and followed.

The investigators concluded that future randomized controlled trials on the subject are warranted, to provide key information on the optimal time of ICU admission and intubation in patients with COVID-19.

Reference  

Le Terrier C, Suh N, Wozniak H, et al. Delayed intubation is associated with mortality in patients with severe COVID-19: a single-centre observational study in Switzerland. Anaesth Crit Care Pain Med. 2022;41(4):101092. doi:10.1016/j.accpm.2022.101092