Faculty Collaboration Database

Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit. J Crit Care 2017 Dec;42:1-5

Date

06/24/2017

Pubmed ID

28641231

DOI

10.1016/j.jcrc.2017.06.010

Scopus ID

2-s2.0-85037988541 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

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.

Author List

Bauer PR, Gajic O, Nanchal R, Kashyap R, Martin-Loeches I, Sakr Y, Jakob SM, François B, Wittebole X, Wunderink RG, Vincent JL, ICON Investigators (Supplemental Appendix 1)

Author

Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

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