Comparative Outcomes Of Early VS Delayed Intubation In Emergency Department Patients With Respiratory Failure

Abstract

Background

The decision to intubate patients with acute respiratory failure in the ED emergency department carries significant importance because it determines their morbidity and mortality outcomes. The need for early intubation exists to prevent respiratory deterioration yet delay in intubation seeks to decrease exposure to invasive mechanical ventilation. Current research about the different clinical results between early and delayed intubation procedures has produced inconsistent findings particularly during recent respiratory pandemic outbreaks such as COVID-19.

Objectives

The research examines how early versus delayed intubation approaches impact clinical results for adult emergency department patients with respiratory failure.

Methodology

We performed our review using the PRISMA methodology. The researchers conducted an extensive database search through PubMed and Scopus and Embase from 2004 to 2024. Research studies that examined intubation timing differences between early and delayed procedures in Emergency Department patients with respiratory failure made the selection cutoff. An assessment of study quality occurred through the utilization of the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized controlled trials. The study evaluated mortality rates together with ventilator-free days duration and ICU stay period and ventilator-associated complications incidence. The analysis used a random-effects model for heterogeneity studies while performing the meta-analysis.

Results

The study included 23 investigations with a collective patient total of 12,678 individuals. Early intubation practice reduced patients' ICU stays by 2.5 days according to pooled data (95% CI: -4.1 to -0.9, p=0.004) even though it showed no significant impact (RR: 0.95, 95% CI: 0.85–1.07, p=0.37) when compared to delayed intubation for mortality rates. The practice of delayed intubation procedures led to increased occurrences of complications related to emergent intubation and ventilator-associated pneumonia. Study heterogeneity was moderate to high because patients diagnosed with or without COVID-19 participated in addition to variations in classification criteria for early and delayed intubation.

Conclusion

Early intubation treatments for ED patients encountering respiratory failure shorten ICU hospitalization duration and decrease procedural difficulties although they demonstrate no conclusive advantage for lowering mortality rates when compared to delayed intubation. The mixed study samples and patient populations make clinical expertise remain the most crucial factor for decision-making. New clinical trials of superior quality need implementation to create definitive strategies.