Factors associated with prolonged intubation among COVID-19 patients in the region of Mahdia (Tunisia)

Introduction: The high mortality among intubated COVID-19 patients in Intensive Care Unit (ICU) has given rise to a debate over risk factors related to a prolonged intubation period. Objectives: In this study, we aimed to identify individual risk factors associated with prolonged intubation (≥ 7 days) among patients with COVID-19. Methods: A prospective study was carried out between September 2020 and february 2021 among patients admitted in the COVID-19 ICU at the University Hospital Tahar Sfar Mahdia. The measurement tool was the “ RAPID CORE CASE REPORT FORM” developed by WHO. Results: A total of 114 participants were enrolled with an average age of 61.4 ± 12.2 years. About 51.4% of patients needed intubation. During the hospitalisation, 12 (21.1%) were eventually extubated and 45 (78.9%) died. Prolonged intubation was recorded in 43.8% of cases. Among them, 35.4% were diabetic, 30.6% have hypertension and 6.1% had chronic heart disease. The main factors significantly associated with longer intubation were: Nosocomial infection (80.8% vs 7.7%;p < 0.01), acute respiratory distress syndrome (60.6% vs 17.8%;p < 0.01), and ionotropic use during the first 24 h (82.4% vs 36%;p < 0.01). Multivariable logistic regression analysis identified nosocomial infection (OR, 20.54 [95% CI, 5.44-77.57] and early invasive intubation (during the first 24 h) (OR, 4.65[95% CI, 1.1-19.56]) as predictive factors of prolonged intubation. Conclusion: As COVID-19 infection continue to rapidly consume the health care system's limited resources, technicians consulted for airway management should consider these factors in their decision making.