Timing of invasive mechanical ventilation and death in critically ill adults with COVID-19: A multicenter cohort study

PLoS One. 2023 Jun 28;18(6):e0285748. doi: 10.1371/journal.pone.0285748. eCollection 2023.

Abstract

Purpose: To investigate if the timing of initiation of invasive mechanical ventilation (IMV) for critically ill patients with COVID-19 is associated with mortality.

Materials and methods: The data for this study were derived from a multicenter cohort study of critically ill adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 1 to July 1, 2020. We examined the association between early (ICU days 1-2) versus late (ICU days 3-7) initiation of IMV and time-to-death. Patients were followed until the first of hospital discharge, death, or 90 days. We adjusted for confounding using a multivariable Cox model.

Results: Among the 1879 patients included in this analysis (1199 male [63.8%]; median age, 63 [IQR, 53-72] years), 1526 (81.2%) initiated IMV early and 353 (18.8%) initiated IMV late. A total of 644 of the 1526 patients (42.2%) in the early IMV group died, and 180 of the 353 (51.0%) in the late IMV group died (adjusted HR 0.77 [95% CI, 0.65-0.93]).

Conclusions: In critically ill adults with respiratory failure from COVID-19, early compared to late initiation of IMV is associated with reduced mortality.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • COVID-19* / therapy
  • Cohort Studies
  • Critical Illness
  • Humans
  • Male
  • Middle Aged
  • Respiration, Artificial
  • SARS-CoV-2