Abstract
Introduction: Switzerland experienced two waves of COVID-19 in 2020, but with a different ICU admission and treatment management strategy. The timing of ICU admission and intubation remains a matter of debate in severe patients. The aim of our study was to describe the characteristics of ICU patients between two subsequent waves of COVID-19 who underwent a different management strategy and to assess whether the timing of intubation was associated with differences in mortality.
Patients and methods: We conducted a prospective observational study of all adult patients with acute respiratory failure due to COVID-19 who required intubation between the 9 th of March 2020 and the 9 th of January 2021 in the intensive care unit (ICU) at Geneva University Hospitals, Switzerland.
Results: Two hundred twenty-three patients were intubated during the study period; 124 during the first wave, and 99 during the second wave. Patients admitted to the ICU during the second wave had a higher SAPS II severity score (52.5 vs. 60; p = 0.01). The time from hospital admission to intubation was significantly longer during the second compared to the first wave (4 days [IQR, 1-7] vs. 2 days [IQR, 0-4]; p < 0.01). All-cause ICU mortality was significantly higher during the second wave (42% vs. 23%; p < 0.01). In a multivariate analysis, the delay between hospital admission and intubation was significantly associated with ICU mortality (OR 3.25 [95% CI, 1.38-7.67]; p < 0.05).
Conclusions: In this observational study, delayed intubation was associated with increased mortality in patients with severe COVID-19. Further randomised controlled trials are needed.
Keywords: Acute respiratory distress syndrome; COVID-19; delayed intubation; intensive care unit; mortality; timing intubation.
【저자키워드】 COVID-19, Mortality, acute respiratory distress syndrome, intensive care unit, delayed intubation, timing intubation., 【초록키워드】 Treatment, randomised controlled trial, Respiratory failure, intensive care, severe COVID-19, prospective observational study, severity, intubation, ICU, Characteristics, management, Patient, ICU admission, second wave, Hospital admission, Switzerland, First wave, Analysis, distress, Intubated, severe patients, increased mortality, Geneva University Hospitals, ICU patient, significantly, subsequent, required, conducted, significantly higher, the timing, 【제목키워드】 intubation, Patient, Switzerland, Delayed,