Authors: Akhilesh VU, Vivek P, Naveen J, Swathy K, Rathenmurugan Mithun, Sreenath Sreelekshmi, Sudhakaran PR, Oommen OV.
Introduction: COVID-19 related ARDS (CARDS) is associated with high mortality. Optimal timing of intubation in these patients is still under research. Early intubation could avoid alternate means of oxygenation like High Frequency Nasal Canula (HFNC) or Non Invasive Ventilation(NIV), which prevents Self Inflicting Lung Injury (SILI) in patients breathing spontaneously. At the same time intubation itself may generate aerosols and delaying of intubation may mean patient could be managed with other means of oxygenation thus preventing Ventilator Induced Lung Injury (VILI). Moreover, the concept of SILI is not supported by scientific data. This study investigated the effect of timing of intubation on 28-day mortality in CARDS patients. Methodology: A retrospective observational study was performed in patients admitted in COVID ICU, between January 1st and August 31st 2021, requiring ventilation. Following data collection patients were categorised into two groups. ‘Delayed ’intubation group consisted of patients receiving Non Re-Breathing Mask (NRBM) /HFNC /NIV initially and got intubated after 24 hrs of ICU admission. The remaining patients who were intubated within 24 hrs comprised the ‘early’ intubation group. The decision for early intubation was made by following the institution protocol for ventilatory management. Results: Among 114 ventilated patients 56 were intubated within 24 hours and 58 were intubated after 24 hours. The 28-day mortality in early and delayed intubation group were 39.7% and 60.3% respectively (p = 0.01). In early intubation group duration of mechanical ventilation (5±1.4), length of ICU stay (7.3±2.1) and hospital stay (9.4±4) were significantly less compared to delayed intubation group (p value <0.05). Conclusion: Decision for intubation is complex and multifactorial which is usually individualized depending on the clinical condition. Early intubation is associated with improved survival rates and reduced duration of mechanical ventilation, length of ICU stay & length of hospital stay in severe CARDS patients.
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