We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

中文翻译：

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插管时间对 COVID-19 重症患者死亡率和肺部后遗症的影响：一项前瞻性队列研究

我们评估了因 COVID-19 而接受有创机械通气 (IMV) 的患者在首次呼吸支持和插管之间的时间是否与死亡率或肺部后遗症相关。IMV 关键 COVID-19 患者的前瞻性队列。如果患者在第一次呼吸支持后的前 48 小时内插管，则将其分类为早期插管，如果稍后插管，则将其分类为延迟插管。出院后对存活的患者进行评估。我们纳入了 205 名患者（140 名早期 IMV 和 65 名延迟 IMV）。[p25;p75] 年龄中位数为 63 [56.0; 70.0]岁，74.1%为男性。生存分析显示延迟组的死亡风险显着增加，调整后的风险比 (HR) 为 2.45 (95% CI 1.29–4.65)。IMV 的连续预测时间与住院死亡率的风险呈非线性关系。多变量死亡率模型显示，IMV 延迟是与死亡率相关的一个因素（HR 为 2.40；95% CI 1.42-4.1）。在随访期间，延迟组患者的 DLCO 更差（平均差为 - 10.77（95% CI - 18.40 至 - 3.15），受影响的肺叶数量更多（+ 1.51 [95% CI 0.89–2.13]）胸部 CT 扫描的 TSS 更高（+ 4.35 [95% CI 2.41–6.27]）。在需要 IMV 的 COVID-19 危重患者中，第一次呼吸支持后插管延迟与住院人数增加有关随访期间死亡率和更严重的肺部后遗症。多变量死亡率模型显示，IMV 延迟是与死亡率相关的一个因素（HR 为 2.40；95% CI 1.42-4.1）。在随访期间，延迟组患者的 DLCO 更差（平均差为 - 10.77（95% CI - 18.40 至 - 3.15），受影响的肺叶数量更多（+ 1.51 [95% CI 0.89–2.13]）胸部 CT 扫描的 TSS 更高（+ 4.35 [95% CI 2.41–6.27]）。在需要 IMV 的 COVID-19 危重患者中，第一次呼吸支持后插管延迟与住院人数增加有关随访期间死亡率和更严重的肺部后遗症。多变量死亡率模型显示，IMV 延迟是与死亡率相关的一个因素（HR 为 2.40；95% CI 1.42-4.1）。在随访期间，延迟组患者的 DLCO 更差（平均差为 - 10.77（95% CI - 18.40 至 - 3.15），受影响的肺叶数量更多（+ 1.51 [95% CI 0.89–2.13]）胸部 CT 扫描的 TSS 更高（+ 4.35 [95% CI 2.41–6.27]）。在需要 IMV 的 COVID-19 危重患者中，第一次呼吸支持后插管延迟与住院人数增加有关随访期间死亡率和更严重的肺部后遗症。35 [95% CI 2.41–6.27]) 在胸部 CT 扫描中。在需要 IMV 的 COVID-19 重症患者中，第一次呼吸支持后插管延迟与住院死亡率增加和随访期间肺部后遗症恶化有关。35 [95% CI 2.41–6.27]) 在胸部 CT 扫描中。在需要 IMV 的 COVID-19 重症患者中，第一次呼吸支持后插管延迟与住院死亡率增加和随访期间肺部后遗症恶化有关。