Factors Associated With Intubation and Prolonged Intubation in Hospitalized Patients With COVID‐19. (19th May 2020)

• Record Type: Journal Article
• Authors: Hur, Kevin; Price, Caroline P. E.; Gray, Elizabeth L.; Gulati, Reeti K.; Maksimoski, Matthew; Racette, Samuel D.; Schneider, Alexander L.; Khanwalkar, Ashoke R.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 163:Number 1(2020)
• Page Start: 170
• Page End: 178
• Publication Date: 2020-05-19
• Subjects: COVID‐19 -- SARS‐CoV‐2 -- coronavirus -- hospitalized -- adults -- mechanical ventilator -- intubation -- tracheostomy; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599820929640
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : 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.