Timing of invasive mechanical ventilation and death in critically ill adults with COVID-19: A multicenter cohort study

• Published in: PloS one Vol. 18; no. 6; p. e0285748
• Main Authors: Green, Adam, Rachoin, Jean-Sebastien, Schorr, Christa, Dellinger, Phil, Casey, Jonathan D, Park, Isabel, Gupta, Shruti, Baron, Rebecca M, Shaefi, Shahzad, Hunter, Krystal, Leaf, David E
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.06.2023; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Analysis; Artificial respiration; Biology and Life Sciences; Body mass index; Cardiovascular disease; Care and treatment; Cohort analysis; Cohort Studies; Complications and side effects; Coronaviruses; COVID-19; COVID-19 - therapy; Critical Illness; Critically ill; Death; Humans; Illnesses; Inflammation; Intubation; Investigations; Laboratories; Lung diseases; Male; Mechanical ventilation; Medicine and Health Sciences; Middle Aged; Missing data; Mortality; Patient outcomes; Patients; Physical Sciences; Research and Analysis Methods; Respiration, Artificial; Respiratory failure; SARS-CoV-2; Variables; Ventilation; Ventilators; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0285748

To investigate if the timing of initiation of invasive mechanical ventilation (IMV) for critically ill patients with COVID-19 is associated with mortality. The data for this study were derived from a multicenter cohort study of critically ill adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 1 to July 1, 2020. We examined the association between early (ICU days 1-2) versus late (ICU days 3-7) initiation of IMV and time-to-death. Patients were followed until the first of hospital discharge, death, or 90 days. We adjusted for confounding using a multivariable Cox model. Among the 1879 patients included in this analysis (1199 male [63.8%]; median age, 63 [IQR, 53-72] years), 1526 (81.2%) initiated IMV early and 353 (18.8%) initiated IMV late. A total of 644 of the 1526 patients (42.2%) in the early IMV group died, and 180 of the 353 (51.0%) in the late IMV group died (adjusted HR 0.77 [95% CI, 0.65-0.93]). In critically ill adults with respiratory failure from COVID-19, early compared to late initiation of IMV is associated with reduced mortality.