More than 70% of the critically ill Covid-19 patients received intubation and invasive mechanical ventilation (IMV) support. [1, 2] Medical professionals throughout the world agree that intubation saves lives. However, there is no direct evidence attesting to the benefit of intubation and IMV in critically ill Covid-19 patients. On the contrary, a report revealed that of 32
Covid-19 patients who received intubation and IMV support, 31 (97%) died. [3] The poor outcome after intubation may be related to the timing of intubation. [4] The role of intubation and IMV amid the Covid-19 pandemic deserves investigation. As it is unethical to perform a randomized controlled trial comparing the outcomes between patients receiving and not receiving intubation and IMV, we conducted a single-center pilot study based on intubated critically ill Covid-19 patients to explore the risks factors associated with mortality.
Patients who received non-resuscitative intubation in the ICU on the Guanggu Campus of Tongji Hospital (Wuhan, China) between February 10, 2020 to March 30, 2020 were included. The ICU was managed by the medical team from Huashan Hospital due to the manpower re-deployment. All patients were diagnosed with Covid-19 and reached the endpoints of either death or survival.
Patients who were intubated during resuscitation and did not survive for more than two hours after resuscitation were excluded.
The study was approved by the Internal Review Board of Huashan Hospital (#2020-655). The primary outcome was the rate of ICU mortality, the differences between survivors and non-survivors were investigated, and the risk factors associated with death in intubated critically ill Covid-19 patients were analyzed by means of univariable and multivariable logistic regression models. (Table 1 ). There were no significant differences between survivors and non-survivors in PaO 2 /FiO 2 and levels of PaCO 2 at the time of intubation and during the early stage of IMV support; however, the differences became significant at the time of IMV weaning for survivals or death ( Table 1 ). The univariable analysis revealed that the odds of ICU mortality were higher in patients with a higher NT-proBNP, INR, SOFA score, and APACHE II score at the time of IMV initiation. A higher SOFA score at the time of IMV initiation was independently associated with an increased risk of death in intubated Covid-19 patients based on multivariable analysis (Supplementary eTable 1).
In conclusion, 76% of critically ill Covid-19 patients died after non-resuscitative intubation and IMV support. Non-survivors had more comorbidities than survivors. Mortality after nonresuscitative intubation in critically ill Covid-19 patients is associated with the disease severity at the time of IMV initiation.
Journal Pre-proof 12.9 (9.8-14.9) 10.0 (7.7-15.0) 0.367 Neutrophils, utr⁹ /L 11.0 (7.9-13.7) 11.9 (9.1-13.7) 9.1 (7. Weaning of invasive mechanical ventilation or death pH* 7.26 (7.08-7.43) 7.14 (7. 