Did intubation procedures for critically ill patients without SARS-CoV-2 infection change during the pandemic? Secondary analysis of the INTUPROS multicenter study

Objective

To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.

Design

Secondary Analysis of the INTUPROS Prospective Multicenter Observational Study on Intubation in Intensive Care Units (ICUs).

Setting

43 Spanish ICUs between April 2019 and October 2020.

Patients

1515 Non-COVID-19 patients intubated before and during the pandemic.

Interventions

None.

Main variables of interest

Intubation procedures and medication, first-pass success rate, complications, and mortality.

Results

1199 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).

Conclusions

The 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.