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Factors Associated With Intubation and Prolonged Intubation in Hospitalized Patients With COVID-19
Kevin Hur1, Caroline P E Price1, Elizabeth L Gray2
1Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Insights
Older, male, and diabetic patients with coronavirus disease 2019 (COVID-19) face higher risks for intubation. Advanced age and obesity increase the likelihood of prolonged intubation in these critical COVID-19 patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) can cause severe respiratory failure requiring mechanical ventilation.
- Identifying predictors for intubation and extubation is crucial for managing COVID-19 patients.
Purpose of the Study:
- To determine risk factors associated with the need for intubation.
- To identify factors influencing the time to extubation in hospitalized COVID-19 patients.
Main Methods:
- Retrospective observational study involving 486 hospitalized COVID-19 patients across ten hospitals.
- Sociodemographic and clinical characteristics were evaluated for association with intubation and prolonged intubation.
Main Results:
- 138 patients (28.4%) required intubation. Older age, male sex, higher respiratory rate, lower oxygen saturation, diabetes, and shortness of breath predicted intubation.
- Intubated patients were older and had higher rates of diabetes compared to non-intubated patients.
- Older age and higher body mass index were independently associated with longer time to extubation.
Conclusions:
- Older, male, and diabetic individuals with COVID-19 are at increased risk for intubation.
- Among intubated patients, advanced age and obesity are linked to prolonged mechanical ventilation.
- These findings aid otolaryngologists in airway management decisions for COVID-19 patients.
Objective:
To identify risk factors associated with intubation and time to extubation in hospitalized patients with coronavirus disease 2019 (COVID-19).
Study Design:
Retrospective observational study.
Setting:
Ten hospitals in the Chicago metropolitan area.
Subjects And Methods:
Patients with laboratory-confirmed COVID-19 admitted between March 1 and April 8, 2020, were included. We evaluated sociodemographic and clinical characteristics associated with intubation and prolonged intubation for acute respiratory failure secondary to COVID-19 infection.
Results:
Of the 486 hospitalized patients included in the study, the median age was 59 years (interquartile range, 47-69); 271 (55.8%) were male; and the median body mass index was 30.6 (interquartile range, 26.5-35.6). During the hospitalization, 138 (28.4%) patients were intubated; 78 (56.5%) were eventually extubated; 21 (15.2%) died; and 39 (28.3%) remained intubated at a mean ± SD follow-up of 19.6 ± 6.7 days. Intubated patients had a significantly higher median age (65 vs 57 years, P < .001) and rate of diabetes (56 [40.6%] vs 104 [29.9%], P = .031) as compared with nonintubated patients. Multivariable logistic regression analysis identified age, sex, respiratory rate, oxygen saturation, history of diabetes, and shortness of breath as factors predictive of intubation. Age and body mass index were the only factors independently associated with time to extubation.
Conclusion:
In addition to clinical signs of respiratory distress, patients with COVID-19 who are older, male, or diabetic are at higher risk of requiring intubation. Among intubated patients, older and more obese patients are at higher risk for prolonged intubation. Otolaryngologists consulted for airway management should consider these factors in their decision making.
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