Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes
Objectives:. Determine the variation in outcomes and respiratory mechanics between the subjects who are intubated earlier versus later in their coronavirus disease 2019 course. Design:. Retrospective cohort study. Setting:. Northwestern Memorial Hospital ICUs. Patients:. All patients intubated for c...
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Wolters Kluwer
2021
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oai:doaj.org-article:a5ecd5f3973e465d9c9346646dbe1a1d2021-11-25T07:55:02ZTiming of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes2639-802810.1097/CCE.0000000000000415https://doaj.org/article/a5ecd5f3973e465d9c9346646dbe1a1d2021-05-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000415https://doaj.org/toc/2639-8028Objectives:. Determine the variation in outcomes and respiratory mechanics between the subjects who are intubated earlier versus later in their coronavirus disease 2019 course. Design:. Retrospective cohort study. Setting:. Northwestern Memorial Hospital ICUs. Patients:. All patients intubated for coronavirus disease 2019 between March 2020 and June 2020. Interventions:. Patients were stratified by time to intubation: 30 subjects were intubated 4–24 hours after presentation and 24 subjects were intubated 5–10 days after presentation. Baseline characteristics, hospitalization, ventilator mechanics, and outcomes were extracted and analyzed. Ten clinically available CT scans were manually reviewed to identify evidence of pulmonary vascular thrombosis and intussusceptive angiogenesis. Measurements and Main Results:. Median time from symptom onset to intubation was significantly different between the early and late intubation cohorts, with the latter being intubated later in the course of their illness (7.9 vs 11.8 d; p = 0.04). The early intubation cohort had a lower mortality rate than the late intubation cohort (6% vs 30%, p < 0.001) without significantly different respiratory mechanics at the time of intubation. The late intubation cohort was noted to have higher dead space ratio (0.40 vs 0.52; p = 0.03). On review of CT scans, the late intubation cohort also had more dilated peripheral segments on imaging (two segments vs five segments). Conclusions:. The question as to whether delaying intubation is beneficial or harmful for patients with coronavirus disease 2019-induced hypoxemic respiratory failure has yet to be answered. As our approaches to coronavirus disease 2019 continue to evolve, the decision of timing of intubation remains paramount. Although noninvasive ventilation may allow for delaying intubation, it is possible that there are downstream effects of delayed intubation that should be considered, including the potential for pulmonary vascular thrombosis and intussusceptive angiogenesis with delayed intubation.Avni A. Bavishi, MD, MSRuben J. Mylvaganam, MDRishi Agarwal, MDRyan J. Avery, MDMichael J. Cuttica, MDFor the NU COVID InvestigatorsA. Christine ArgentoAjay A. WaghAlexander V. MisharinAlexandra C. McQuattie-PimentelAlexis Rose WolfeAlvaro DonayreAnkit BharatAnna E. PawlowskiAnne R. LevensonAnthony M. JoudiBenjamin D. SingerBetty TranCatherine A. GaoChao QiChiagozie O. PickensChitaru KuriharaClara J. SchroedlDaniel MezaDaniel SchneiderDavid A. KiddDavid D. OdellDavid W. KampElizabeth S. MalsinEmily M. LeibenguthEric P. CanteyGabrielle Y. LiuG. R. Scott BudingerHelen K. DonnellyIsaac A. GoldbergJacob I. SznajderJacqueline M. KruserJames M. WalterJane E. DematteJason M. ArnoldJohn ColemanJoseph I. BaileyJoseph S. DetersJustin A. FialaKatharine SecundaKaitlyn VitaleKhalilah L. GatesKristy ToddLindsey D. GradoneLindsey N. TextorLisa F. WolfeLorenzo L. PesceLuisa Morales-NebredaMadeline L. RosenbaumManu JainMarc A. SalaMary CarnsMarysa V. LeyaMengjia KangMichael J. AlexanderMichael J. CutticaMichelle Hinsch PrickettNatalie JensemaNicole BorkowskiNikolay S. MarkovOrlyn R. RivasPaul A. ReyfmanPeter H. S. SpornPrasanth NannapaneniRachel B. KadarRachel M. KaplanRade TomicRadhika PatelRafael Garza-CastillonRavi KalhanRichard G. WunderinkRogan A. GrantRomy LawrenceRuben J. MylvaganamSamuel S. KimSanket ThakkarSean B. SmithSeungHye HanSharon R. RosenbergSusan R. RussellSydney M. HyderTaylor A. PoorTheresa A. LombardoZasu M. KlugWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 5, p e0415 (2021) |
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DOAJ |
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EN |
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Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 |
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Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Avni A. Bavishi, MD, MS Ruben J. Mylvaganam, MD Rishi Agarwal, MD Ryan J. Avery, MD Michael J. Cuttica, MD For the NU COVID Investigators A. Christine Argento Ajay A. Wagh Alexander V. Misharin Alexandra C. McQuattie-Pimentel Alexis Rose Wolfe Alvaro Donayre Ankit Bharat Anna E. Pawlowski Anne R. Levenson Anthony M. Joudi Benjamin D. Singer Betty Tran Catherine A. Gao Chao Qi Chiagozie O. Pickens Chitaru Kurihara Clara J. Schroedl Daniel Meza Daniel Schneider David A. Kidd David D. Odell David W. Kamp Elizabeth S. Malsin Emily M. Leibenguth Eric P. Cantey Gabrielle Y. Liu G. R. Scott Budinger Helen K. Donnelly Isaac A. Goldberg Jacob I. Sznajder Jacqueline M. Kruser James M. Walter Jane E. Dematte Jason M. Arnold John Coleman Joseph I. Bailey Joseph S. Deters Justin A. Fiala Katharine Secunda Kaitlyn Vitale Khalilah L. Gates Kristy Todd Lindsey D. Gradone Lindsey N. Textor Lisa F. Wolfe Lorenzo L. Pesce Luisa Morales-Nebreda Madeline L. Rosenbaum Manu Jain Marc A. Sala Mary Carns Marysa V. Leya Mengjia Kang Michael J. Alexander Michael J. Cuttica Michelle Hinsch Prickett Natalie Jensema Nicole Borkowski Nikolay S. Markov Orlyn R. Rivas Paul A. Reyfman Peter H. S. Sporn Prasanth Nannapaneni Rachel B. Kadar Rachel M. Kaplan Rade Tomic Radhika Patel Rafael Garza-Castillon Ravi Kalhan Richard G. Wunderink Rogan A. Grant Romy Lawrence Ruben J. Mylvaganam Samuel S. Kim Sanket Thakkar Sean B. Smith SeungHye Han Sharon R. Rosenberg Susan R. Russell Sydney M. Hyder Taylor A. Poor Theresa A. Lombardo Zasu M. Klug Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes |
| description |
Objectives:. Determine the variation in outcomes and respiratory mechanics between the subjects who are intubated earlier versus later in their coronavirus disease 2019 course.
Design:. Retrospective cohort study.
Setting:. Northwestern Memorial Hospital ICUs.
Patients:. All patients intubated for coronavirus disease 2019 between March 2020 and June 2020.
Interventions:. Patients were stratified by time to intubation: 30 subjects were intubated 4–24 hours after presentation and 24 subjects were intubated 5–10 days after presentation. Baseline characteristics, hospitalization, ventilator mechanics, and outcomes were extracted and analyzed. Ten clinically available CT scans were manually reviewed to identify evidence of pulmonary vascular thrombosis and intussusceptive angiogenesis.
Measurements and Main Results:. Median time from symptom onset to intubation was significantly different between the early and late intubation cohorts, with the latter being intubated later in the course of their illness (7.9 vs 11.8 d; p = 0.04). The early intubation cohort had a lower mortality rate than the late intubation cohort (6% vs 30%, p < 0.001) without significantly different respiratory mechanics at the time of intubation. The late intubation cohort was noted to have higher dead space ratio (0.40 vs 0.52; p = 0.03). On review of CT scans, the late intubation cohort also had more dilated peripheral segments on imaging (two segments vs five segments).
Conclusions:. The question as to whether delaying intubation is beneficial or harmful for patients with coronavirus disease 2019-induced hypoxemic respiratory failure has yet to be answered. As our approaches to coronavirus disease 2019 continue to evolve, the decision of timing of intubation remains paramount. Although noninvasive ventilation may allow for delaying intubation, it is possible that there are downstream effects of delayed intubation that should be considered, including the potential for pulmonary vascular thrombosis and intussusceptive angiogenesis with delayed intubation. |
| format |
article |
| author |
Avni A. Bavishi, MD, MS Ruben J. Mylvaganam, MD Rishi Agarwal, MD Ryan J. Avery, MD Michael J. Cuttica, MD For the NU COVID Investigators A. Christine Argento Ajay A. Wagh Alexander V. Misharin Alexandra C. McQuattie-Pimentel Alexis Rose Wolfe Alvaro Donayre Ankit Bharat Anna E. Pawlowski Anne R. Levenson Anthony M. Joudi Benjamin D. Singer Betty Tran Catherine A. Gao Chao Qi Chiagozie O. Pickens Chitaru Kurihara Clara J. Schroedl Daniel Meza Daniel Schneider David A. Kidd David D. Odell David W. Kamp Elizabeth S. Malsin Emily M. Leibenguth Eric P. Cantey Gabrielle Y. Liu G. R. Scott Budinger Helen K. Donnelly Isaac A. Goldberg Jacob I. Sznajder Jacqueline M. Kruser James M. Walter Jane E. Dematte Jason M. Arnold John Coleman Joseph I. Bailey Joseph S. Deters Justin A. Fiala Katharine Secunda Kaitlyn Vitale Khalilah L. Gates Kristy Todd Lindsey D. Gradone Lindsey N. Textor Lisa F. Wolfe Lorenzo L. Pesce Luisa Morales-Nebreda Madeline L. Rosenbaum Manu Jain Marc A. Sala Mary Carns Marysa V. Leya Mengjia Kang Michael J. Alexander Michael J. Cuttica Michelle Hinsch Prickett Natalie Jensema Nicole Borkowski Nikolay S. Markov Orlyn R. Rivas Paul A. Reyfman Peter H. S. Sporn Prasanth Nannapaneni Rachel B. Kadar Rachel M. Kaplan Rade Tomic Radhika Patel Rafael Garza-Castillon Ravi Kalhan Richard G. Wunderink Rogan A. Grant Romy Lawrence Ruben J. Mylvaganam Samuel S. Kim Sanket Thakkar Sean B. Smith SeungHye Han Sharon R. Rosenberg Susan R. Russell Sydney M. Hyder Taylor A. Poor Theresa A. Lombardo Zasu M. Klug |
| author_facet |
Avni A. Bavishi, MD, MS Ruben J. Mylvaganam, MD Rishi Agarwal, MD Ryan J. Avery, MD Michael J. Cuttica, MD For the NU COVID Investigators A. Christine Argento Ajay A. Wagh Alexander V. Misharin Alexandra C. McQuattie-Pimentel Alexis Rose Wolfe Alvaro Donayre Ankit Bharat Anna E. Pawlowski Anne R. Levenson Anthony M. Joudi Benjamin D. Singer Betty Tran Catherine A. Gao Chao Qi Chiagozie O. Pickens Chitaru Kurihara Clara J. Schroedl Daniel Meza Daniel Schneider David A. Kidd David D. Odell David W. Kamp Elizabeth S. Malsin Emily M. Leibenguth Eric P. Cantey Gabrielle Y. Liu G. R. Scott Budinger Helen K. Donnelly Isaac A. Goldberg Jacob I. Sznajder Jacqueline M. Kruser James M. Walter Jane E. Dematte Jason M. Arnold John Coleman Joseph I. Bailey Joseph S. Deters Justin A. Fiala Katharine Secunda Kaitlyn Vitale Khalilah L. Gates Kristy Todd Lindsey D. Gradone Lindsey N. Textor Lisa F. Wolfe Lorenzo L. Pesce Luisa Morales-Nebreda Madeline L. Rosenbaum Manu Jain Marc A. Sala Mary Carns Marysa V. Leya Mengjia Kang Michael J. Alexander Michael J. Cuttica Michelle Hinsch Prickett Natalie Jensema Nicole Borkowski Nikolay S. Markov Orlyn R. Rivas Paul A. Reyfman Peter H. S. Sporn Prasanth Nannapaneni Rachel B. Kadar Rachel M. Kaplan Rade Tomic Radhika Patel Rafael Garza-Castillon Ravi Kalhan Richard G. Wunderink Rogan A. Grant Romy Lawrence Ruben J. Mylvaganam Samuel S. Kim Sanket Thakkar Sean B. Smith SeungHye Han Sharon R. Rosenberg Susan R. Russell Sydney M. Hyder Taylor A. Poor Theresa A. Lombardo Zasu M. Klug |
| author_sort |
Avni A. Bavishi, MD, MS |
| title |
Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes |
| title_short |
Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes |
| title_full |
Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes |
| title_fullStr |
Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes |
| title_full_unstemmed |
Timing of Intubation in Coronavirus Disease 2019: A Study of Ventilator Mechanics, Imaging, Findings, and Outcomes |
| title_sort |
timing of intubation in coronavirus disease 2019: a study of ventilator mechanics, imaging, findings, and outcomes |
| publisher |
Wolters Kluwer |
| publishDate |
2021 |
| url |
https://doaj.org/article/a5ecd5f3973e465d9c9346646dbe1a1d |
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