A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects

Suraj Trivedi; Diana Hylton; Matthew Mueller; Ilona Juan; Christie Mun; Eric Tzeng; Patricia Guan; Maya Filipovic; Sohaib Mandoorah; Alyssa Brezenski; E Orestes O'Brien; Atul Malhotra; Ulrich Schmidt

doi:10.7759/cureus.35145

A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects

Cureus. 2023 Feb 18;15(2):e35145. doi: 10.7759/cureus.35145. eCollection 2023 Feb.

Authors

Affiliations

¹ Anesthesia and Critical Care, University of California San Diego School of Medicine, San Diego, USA.
² Anesthesia and Critical Care, University of California San Diego, San Diego, USA.
³ Critical Care Medicine, University of California San Diego, Washington, DC, USA.
⁴ Anesthesiology, Kaiser San Diego, San Diego, USA.
⁵ Anesthesiology, University of California San Diego, San Diego, USA.
⁶ Critical Care Medicine, University of California San Diego, San Diego, USA.
⁷ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, USA.

Abstract

Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020. With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly. We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU). We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020 and June 2020 to determine if they met the inclusion criteria. These subjects were required to be spontaneously ventilating upon admission and eventually required intubation. Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospective ICU admission analysis. We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects. Our primary outcome of interest was intubation-related mortality. We defined intubation mortality as unexpected death (within 48 hours of intubation). Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress. COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects. COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P < 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed the rates of intubation survival were no different between the COVID and non-COVID groups. We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process.

Keywords: coronavirus disease 2019; covid-19; difficult airway management; endotracheal intubations; intubation response; post-intubation complications.