Intubation Timing and Critical Care Outcomes in Patients Without COVID-19

Among critically ill patients who do not have COVID-19, early intubation is associated with a lower mortality rate, according to findings and an analysis published recently in the Journal of Critical Care.

Early intubation of critically ill patients may result in airway injury, the need for sedation, and complications such as ventilator-associated pneumonia. Because of this, clinicians may favor a wait-and-see approach to intubation, said researchers conducting the current meta-analysis.

The researchers therefore sought to investigate the timing of intubation among critically ill patients and its association with clinical outcomes through a systematic review and meta-analysis. A total of 27 studies (24 observational studies, 3 randomized controlled trials; no language restrictions) from the PubMed database published through early November 2021 were reviewed. The studies included more than 15,000 critically ill patients at least 18 years of age experiencing early (n=11,943) vs late (n=3498) intubation.

“Early” intubation was specifically defined by each study. The primary endpoint was all-cause death. Statistical heterogeneity (I² = 31%) was not important. No publication bias was found (P >.05). Notably, none of these studies involved patients with COVID-19, given that this patient population was previously analyzed and was not part of the current investigation.  

The investigators found that all-cause mortality (7338 deaths) was lower in patients with early intubation vs late intubation (45.8% vs 53.5%, respectively; risk ratio [RR] 0.92; 95% CI, 0.87-0.97; P =.001), Results were similar in subgroup analysis with “early” defined as intubation within 24 hours of intensive care admission (6279 deaths; mortality from early vs late intubation 45.8% vs 53.6%, respectively; RR 0.93; 95% CI, 0.89–0.98; P =.005).

Researchers acknowledged that the study was limited by varying definitions of “early” intubation used in the studies selected; however, they noted that findings were maintained when subgroup analysis defined “early” as within 24 hours of ICU admission.

The investigators concluded that “all-cause mortality was lower in patients undergoing early vs late intubation. This finding suggests that avoiding late intubation may be associated with lower mortality in critically ill patients without COVID-19.”

Reference

Xixi NA, Kremmydas P, Xourgia E, Giannopoulou V, Sarri K, Siempos II. Association between timing of intubation and clinical outcomes of critically ill patients: A meta-analysis. J Crit Care. Published online May 16, 2022. doi:10.1016/j.jcrc.2022.154062