Early versus delayed intubation and technique in COVID-19

Novel coronavirus 2019 is the cause of the 2020 pandemic that was announced by the world health organization in March 2020. Coronavirus attacks the respiratory system and causes mild to severe hypoxemia. Therefore, a fraction of COVID-19 patients may need intubation and mechanical ventilation.

We performed a narrative review via searching in articles that were published in PubMed, Google Scholar, Scopus, web of scenic, Cochrane library, and Embase that mentioned to time of intubation COVID-19 patients and intubation techniques, manual searching was also completed. All the selected reviews and studies were limited to humans and the English language.

First data from China mention that 5% of patients requiring intubation and mechanical ventilation (MV), there has been substantial debate about the time of intubation to patients with acute respiratory failure and intubation technique. At first, the specialists recommended early intubation. Although we are more familiar with the pathophysiology of coronavirus, the drawbacks versus the benefits of early intubation are still controversial. In addition, the intubation process itself is an aerosol-generating procedure and a high risk for patients and health care providers. In this review, we aim to review the previous studies and guidelines recommendations related to the time of intubation and intubation technique for COVID-19 patients.

Some previous studies suggested early tracheal intubation in severe COVID-19 patients may have the priority, while other studies advocate late intubation due to poor outcomes of intubation and weaning difficulties. However, intubation timing should be based on personalized medicine and case by case decision making to keep the best care and benefit of patients. And relying only on theoretical justification may have not good consequences.