Timing to Intubation COVID-19 Patients: Can We Put It Off Until Tomorrow?

Abstract Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the relationship between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all adult laboratory-confirmed SARS-CoV-2 infection consecutively admitted at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortalityResults: A total of 592 (20%) adult consecutive patients out of 3020 admitted with COVID-19 were intubated during the study period. The median time from admission to intubation was one day (interquartile range, 0-3), and 310 patients (52%) who were intubated and mechanically ventilated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03).Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality.Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068.