To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.
DesignSecondary Analysis of the INTUPROS Prospective Multicenter Observational Study on Intubation in Intensive Care Units (ICUs).
Setting43 Spanish ICUs between April 2019 and October 2020.
Patients1515 Non-COVID-19 patients intubated before and during the pandemic.
InterventionsNone.
Main variables of interestIntubation procedures and medication, first-pass success rate, complications, and mortality.
Results1199 patients intubated before the pandemic and 316 during the pandemic were analyzed. During the pandemic, there were fewer days until intubation (OR 0.95 95% CI [0.92−0.98]), reduced resuscitation bag (OR 0.43 95% CI [0.29−0.63]) and non-invasive ventilation oxygenation (OR 0.51 95% CI [0.34−0.76]), reduced use of capnography (OR 0.55 95% CI [0.33−0.92]) and fentanyl (OR 0.47 95% CI [0.34−0.63]). On the other hand, there was an increase in oxygenation with non-HFNC devices (OR 2.21 95% CI [1.23–3.96]), in use of videolaryngoscopy on the first-pass (OR 2.74 95% CI [1.76–4.24]), and greater use of midazolam (OR 1.95 95% CI [1.39–2.72]), etomidate (OR 1.78 95% CI [1.28–2.47]) and succinylcholine (OR 2.55 95% CI [1.82–3.58]). The first-pass success was higher (68.5% vs. 74.7%; P=.033). There were no pre-post differences in major complications (34.7% vs. 34.8%; P=.970) and in-hospital mortality (42.7% vs. 38.6%; P=.137).
ConclusionsThe COVID-19 pandemic modified intubation procedures in non-COVID-19 patients, changing the oxygenation strategy, the medication and the use of videolaryngoscopy, with no impact on complications or mortality.
Determinar los cambios en los procedimientos de intubación que la pandemia COVID-19 generó en la atención de los pacientes críticos sin infección por SARS-CoV-2.
DiseñoAnálisis secundario del estudio prospectivo multicéntrico observacional INTUPROS sobre intubación en unidades de cuidados intensivos (UCI).
Ámbito43 UCI españolas entre abril 2019 y octubre 2020.
Pacientes1515 pacientes No-COVID-19 intubados antes y durante la pandemia.
IntervencionesNinguna.
Variables de interés principalesProcedimientos y medicación para la intubación, tasa de intubación a la primera, complicaciones y mortalidad.
ResultadosSe analizan 1199 pacientes intubados antes de la pandemia y 316 en pandemia. En pandemia, hubo menos días hasta la intubación (OR 0,95 IC 95% [0,92–0,98]), menor oxigenación con balón (OR 0,43 IC 95% [0,29–0,63]) y ventilación no invasiva (OR 0,51 IC 95% [0,34–0,76]), menor uso de capnografía (OR 0,55 IC 95% [0,33–0,92]) y de fentanilo (OR 0,47 IC 95% [0,34–0,63]). Por contra, hubo mayor oxigenación con dispositivos no ONAF (OR 2,21 IC 95% [1,23–3,96]), mayor videolaringoscopia al primer intento (OR 2,74 IC 95% [1,76–4,24]), y mayor uso de midazolam (OR 1,95 IC 95%[1,39–2,72]), etomidato (OR 1,78 IC 95%[1,28–2,47]) y succinilcolina (OR 2,55 IC 95%[1,82–3,58]). La tasa de intubación a la primera fue superior (68,5% vs.74,7%; P=,033). No hubo diferencias pre-post en complicaciones mayores (34,7% vs. 34,8%; P=,970) y mortalidad hospitalaria (42,7% vs. 38,6%; P=,137).
ConclusionesLa pandemia COVID-19 modificó los procedimientos de intubación en pacientes No-COVID-19, cambiando la estrategia de oxigenación, la medicación utilizada y el uso de videolaringoscopia, sin generar impacto en complicaciones o mortalidad.
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