Invasive Ventilation and Increased COVID-19 Mortality: A Propensity-Score Matched Retrospective Cohort Study

Rationale: There has been controversy about the timing and safety of intubation and mechanical ventilation in coronavirus disease (COVID-19).Objectives: To determine the effect of intubation and mechanical ventilation on all-cause, in-hospital mortality for COVID-19 patients.Methods: Retrospective cohort study of adult patients who tested positive for COVID-19 in the emergency department and were subsequently admitted to one of 11 New York City municipal hospitals. Patients with do not intubate orders were excluded.Measurements and Main Results: Data from 6591 COVID-19 patients were included;of these, 1633 (25%) were intubated overall and 791 (12%) were intubated within 48 hours of triage. After controlling for likely confounders, intubation rates for COVID-19 patients varied significantly across hospitals and decreased as the pandemic progressed. After nearest neighbor propensity score matching, intubation within 48 hours of triage was associated with higher allcause mortality (hazard ratio = 1.34, 1.09 to 1.65, p = 0.006), as was intubation at any time point (hazard ratio = 1.22, 1.02 to 1.45, p = 0.026). These results remained robust to multiple sensitivity analyses.Conclusions: Intubation and mechanical ventilation was associated with increased mortality in COVID-19 patients. Further caution should be taken in attempting to avoid intubating these patients.