Does the Timing of Intubation and IMV Impact Clinical Outcomes in Adult COVID-19 Patients with ARDS: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background/Aim: COVID-19 can rapidly develop into acute lung injury, and even acute respiratory distress syndrome (ARDS), which has a high risk of death.Patients with ARDS often require intubation.However, the timing of intubation and its effect on clinical outcomes in COVID-19 ARDS (CARDS) patients remains unclear.Thus, the authors explored the impact of intubation time on clinical outcomes in COVID-19 patients with ARDS through a systematic review and meta-analysis. Materials and Methods:Research articles from PUBMED, CINAHL, MEDLINE, ProQuest Covid database, and Web of Science were searched through December 2021.All patients in the research met the Berlin criteria for ARDS.For the purposes of this review, "Early" intubation was defined as intubation within 24 hours of an ARDS diagnosis, while "Late" was defined as 24 or more hours after diagnosis.The primary outcome was ICU mortality, and secondary measures included length of ICU stay and duration of mechanical ventilation.The meta-analysis was performed using a random-effects model.The quality of cohort studies was assessed using the Newcastle-Ottawa Scale.The methodological quality of the overall evidence in this review was evaluated using the GRADE approach.Results: After an extensive search, six cohort studies were ultimately included in the systematic review, altogether encompassing 2,739 patients with CARDS.A meta-analysis revealed statistically significant differences in mortality [risk ratio (RR)=0.78;95% confidence interval (CI),0.69-0.88;Z=3.91, P < 0.0001)].The mortality rate was 36.2% (817 deaths) in the early group and 48.2% (229 deaths) in the late group, respectively.Results of the narrative analysis showed that early intubation resulted in shorter ICU stays, which was statistically significant.However, no statistical difference was found in the duration of mechanical ventilation. Conclusions:Early intubation can reduce mortality and length of ICU stay in adult COVID-19 patients with ARDS.However, the timing of intubation did not affect the duration of continuous mechanical ventilation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.044 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".