Journal article
Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit.
- Bauer PR Dept of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address: Bauer.Philippe@mayo.edu.
- Gajic O Dept of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
- Nanchal R Dept of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Kashyap R Dept of Anesthesia Clinical Research, Mayo Clinic, Rochester, MN, USA.
- Martin-Loeches I Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli University Institute, Sabadell, Spain.
- Sakr Y Dept of Anesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany.
- Jakob SM Dept of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland.
- François B Inserm CIC 1435, UMR 1092, Service de Réanimation Polyvalente, CHU Dupuytren, 87042 Limoges cedex, France.
- Wittebole X Critical Care Dept, Cliniques Universitaires St Luc, UCL, Brussels, Belgium.
- Wunderink RG Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Vincent JL Dept of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
- 2017-06-23
Published in:
- Journal of critical care. - 2017
Endotracheal intubation
Logistic regression
Mechanical ventilation
Propensity score
Aged
Clinical Audit
Critical Illness
Female
Humans
Intensive Care Units
Intubation, Intratracheal
Length of Stay
Middle Aged
Proportional Hazards Models
Prospective Studies
Respiration, Artificial
Time Factors
English
PURPOSE
The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined.
MATERIAL AND METHODS
In a secondary analysis of the large, prospective ICON database, we used a piecewise proportional hazards model to compare outcomes in patients who underwent intubation early (within two days after intensive care unit [ICU] admission) or later.
RESULTS
After excluding 5340 patients already intubated on admission or with therapeutic limitation, 4729 patients were analyzed, of whom 4074 never underwent intubation. Of the remaining 655 patients, 449 underwent intubation early and 206 later. Despite similar severity scores on ICU admission, unadjusted ICU (27.6 vs. 18.2%) and hospital (33.3 vs. 23.4%) mortality rates were higher in patients intubated later than in those intubated earlier, as were ICU (9 [5-16] vs. 4 [2-9] days) and hospital (24 [9-35] vs. 13 [7-24] days) lengths-of-stay (all p<0.001). After adjustment, the hazard for ICU and hospital death was significantly greater >10days after ICU admission for patients intubated late.
CONCLUSIONS
In this large cohort of critically ill patients requiring intubation, intubation >2days after admission was associated with increased mortality later in the hospital course.
The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined.
MATERIAL AND METHODS
In a secondary analysis of the large, prospective ICON database, we used a piecewise proportional hazards model to compare outcomes in patients who underwent intubation early (within two days after intensive care unit [ICU] admission) or later.
RESULTS
After excluding 5340 patients already intubated on admission or with therapeutic limitation, 4729 patients were analyzed, of whom 4074 never underwent intubation. Of the remaining 655 patients, 449 underwent intubation early and 206 later. Despite similar severity scores on ICU admission, unadjusted ICU (27.6 vs. 18.2%) and hospital (33.3 vs. 23.4%) mortality rates were higher in patients intubated later than in those intubated earlier, as were ICU (9 [5-16] vs. 4 [2-9] days) and hospital (24 [9-35] vs. 13 [7-24] days) lengths-of-stay (all p<0.001). After adjustment, the hazard for ICU and hospital death was significantly greater >10days after ICU admission for patients intubated late.
CONCLUSIONS
In this large cohort of critically ill patients requiring intubation, intubation >2days after admission was associated with increased mortality later in the hospital course.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jcrc.2017.06.010
- PMID 28641231
- Persistent URL
- https://folia.unifr.ch/global/documents/173361
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