Predictive Factors for Intubation in Coronavirus Disease Patients Admitted in the ICU

Main Article Content

Constance Bayon, MD Charles Detollenaere, MD Raphaël Favory, MD, PhD Erika Parmentier-Decrucq, MD


What is already known

Clinical features have also been described as predictors for poor outcomes: initial fever is associated with an increased risk of hospitalization, but does not seem to be a discriminating factor in the development of critical illness. Initial dyspnea is linked to severe and critical forms and digestive symptoms are associated with severe forms. Only hypoxemia was a predictor for mechanical ventilation in the first 48 hours. Yet many hypoxemic patients show very few signs of respiratory distress, as in « silent hypoxemia ».


What is new in the current study

The clinical assessment of respiratory mechanics is one of the best ways to predict the need for invasive ventilation. Deferring intubation in patients at very high risk of requiring mechanical ventilation could deteriorate respiratory status and lead to increased ventilatory difficulties following intubation.



Object: Since it began in Wuhan in December 2019, the Coronavirus Disease pandemic has affected more than 500 million people and caused more than 6 million deaths. Identifying risk factors for severe cases has become a major issue. We evaluated whether patient characteristics upon intensive care unit admission could predict later intubation. We also compared outcomes for patients undergoing early versus delayed intubation.

Methods: This is a retrospective, monocentric study carried out in a medical university intensive care unit between August 2020 and January 2021. Demographic, clinical, biological and imaging data were collected (on arrival and on day 2). We examined intubation timing (before or after 48h hours after intensive care unit admission), ventilatory features and outcomes for intubated patients.

Results: SAPS2, high steroid dosages, pulmonary superinfection, extensive CT pulmonary lesions, polypnea and elevated oxygen requirements were associated with a higher need of intubation. Biological features on admission were non-discriminatory. Delayed intubation seemed to be associated with more severe acute respiratory distress syndrome, but mortality did not vary.

Discussion and conclusion: Intubation can be predicted using a multimodal approach including clinical and imaging features. Early clinical evaluation plays a key role in identifying patients likely to be intubated. Delaying intubation could lead to respiratory worsening.

Keywords: Coronavirus Disease appeared in 2019, severe acute respiratory syndrome, mechanical ventilation, intubation, Non-Invasive Ventilation

Article Details

How to Cite
BAYON, Constance et al. Predictive Factors for Intubation in Coronavirus Disease Patients Admitted in the ICU. Medical Research Archives, [S.l.], v. 11, n. 3, mar. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 20 apr. 2024. doi:
Research Articles


1. WHO Coronavirus (COVID-19) Dashboard.
2. Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovascular Research. 2020 Dec 1;116(14):2197–2206.
3. Gao Y, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID‐19 patients: A review. Allergy. 2021 Feb;76(2):428–455.
4. Evans PC, Rainger GE, Mason JC, et al. Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science. Cardiovascular Research. 2020 Dec 1;116(14):2177–2184.
5. Chen X, Hu W, Ling J, et al. Hypertension and Diabetes Delay the Viral Clearance in COVID-19 Patients. Infectious Diseases (except HIV/AIDS); 2020 Mar. Available from:
6. Andrade FB, Gualberto A, Rezende C, Percegoni N, Gameiro J, Hottz ED. The Weight of Obesity in Immunity from Influenza to COVID-19. Front Cell Infect Microbiol. 2021;11:638852. PMCID: PMC8011498
7. Kwaifa IK, Bahari H, Yong YK, Noor SM. Endothelial Dysfunction in Obesity-Induced Inflammation: Molecular Mechanisms and Clinical Implications. Biomolecules. 2020 Feb 13;10(2). PMCID: PMC7072669
8. Drucker DJ. Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning. Cell Metab. 2021 Mar 2;33(3):479–498. PMCID: PMC7825982
9. Chee YJ, Tan SK, Yeoh E. Dissecting the interaction between COVID-19 and diabetes mellitus. J Diabetes Investig. 2020 Sep;11(5):1104–1114. PMCID: PMC7323255
10. Halpin DMG, Criner GJ, Papi A, et al. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2021 Jan 1;203(1):24–36. PMCID: PMC7781116
11. Drake TM, Docherty AB, Harrison EM, et al. Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study. Am J Respir Crit Care Med. 2020 Dec 15;202(12):1656–1665. PMCID: PMC7737581
12. Marjot T, Moon AM, Cook JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2021 Mar;74(3):567–577. PMCID: PMC7536538
13. Marjot T, Webb GJ, Barritt AS, Moon AM, Stamataki Z, Wong VW, Barnes E. COVID-19 and liver disease: mechanistic and clinical perspectives. Nat Rev Gastroenterol Hepatol. 2021 May;18(5):348–364. PMCID: PMC7945972
14. Askari H, Sanadgol N, Azarnezhad A, Tet al. Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives. Heliyon. 2021 Jan;7(1):e06008. PMCID: PMC7817396
15. Pathania AS, Prathipati P, Abdul BA, et al. COVID-19 and Cancer Comorbidity: Therapeutic Opportunities and Challenges. Theranostics. 2021;11(2):731–753. PMCID: PMC7738845
16. Carmichael H, Coquet J, Sun R, et al. Learning from past respiratory failure patients to triage COVID-19 patient ventilator needs: A multi-institutional study. J Biomed Inform. 2021 May 27;119:103802. PMCID: PMC8159260
17. Nouri-Vaskeh M, Sharifi A, Khalili N, Zand R, Sharific A. Dyspneic and non-dyspneic (silent) hypoxemia in COVID-19: Possible neurological mechanism. Clin Neurol Neurosurg. 2020 Nov;
18. Huang G, Kovalic AJ, Graber CJ. Prognostic Value of Leukocytosis and Lymphopenia for Coronavirus Disease Severity. Emerg Infect Dis. 2020 Aug;26(8):1839–1841. PMCID: PMC7392413
19. Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020 Jul;146(1):128-136.e4. PMCID: PMC7233239
20. Kim JS, Lee JY, Yang JW, et al. Immunopathogenesis and treatment of cytokine storm in COVID-19. Theranostics. 2021;11(1):316–329. PMCID: PMC7681075
21. Li W, Lin F, Dai M, et al. Early predictors for mechanical ventilation in COVID-19 patients. Ther Adv Respir Dis. 2020 Jan;14:175346662096301.
22. Cruces P, Retamal J, Hurtado DE, et al. A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection. Crit Care. 2020 Dec;24(1):494.
23. Piquilloud L, Mercat A. Stress et strain : application au cours du syndrome de détresse respiratoire aiguë. Réanimation. 2014 Jul;23(4):412–419.
24. Easton PA, Slykerman LJ, Anthonisen NR. Ventilatory response to sustained hypoxia in normal adults. Journal of Applied Physiology. 1986 Sep 1;61(3):906–911.
25. Segers LS, Nuding SC, Ott MM, et al. Peripheral chemoreceptors tune inspiratory drive via tonic expiratory neuron hubs in the medullary ventral respiratory column network. Journal of Neurophysiology. 2015 Jan 1;113(1):352–368.
26. Papoutsi E, Giannakoulis VG, Xourgia E, Routsi C, Kotanidou A, Siempos II. Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies. Crit Care. 2021 Dec;25(1):121.
27. Marini JJ, Gattinoni L. Management of COVID-19 Respiratory Distress. JAMA. 2020 Jun 9;323(22):2329.
28. Raschke RA, Agarwal S, Rangan P, Heise CW, Curry SC. Discriminant Accuracy of the SOFA Score for Determining the Probable Mortality of Patients With COVID-19 Pneumonia Requiring Mechanical Ventilation. JAMA. 2021 Apr 13;325(14):1469.
29. Wilfong EM, Lovly CM, Gillaspie EA, et al. Severity of illness scores at presentation predict ICU admission and mortality in COVID-19. J Emerg Crit Care Med. 2021 Jan;5:7–7.
30. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061.
31. COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021 Jan;47(1):60–73.
32. Yoshida Y, Takeda S, Akada S, Hongo T, Tanaka K, Sakamoto A. Factors predicting successful noninvasive ventilation in acute lung injury. Journal of Anesthesia. 2008;(22):201–206.
33. Carron M, Freo U, Zorzi M, Ori C. Predictors of failure of noninvasive ventilation in patients with severe community-acquired pneumonia. Journal of Critical Care. 2010 Sep;25(3):540.e9-540.e14.
34. Menga LS, Cese LD, Bongiovanni F, et al. High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19. Respir Care. 2021 May;66(5):705–714.
35. Beduneau G, Boyer D, Guitard PG, et al. Covid-19 severe hypoxemic pneumonia: A clinical experience using high-flow nasal oxygen therapy as first-line management. Respiratory Medicine and Research. 2021 Nov;80:100834.
36. Yoon SH, Lee KH, Kim JY, et al. Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol. 2020;21(4):494.
37. Islam N, Ebrahimzadeh S, Salameh JP, et al. Thoracic imaging tests for the diagnosis of COVID-19. Cochrane Infectious Diseases Group, editor. Cochrane Database of Systematic Reviews. 2021 Mar 16; Available from:
38. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. American Journal of Roentgenology. 2020 May;214(5):1072–1077.
39. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 Mar;395(10229):1054–1062.
40. Li X, Marmar T, Xu Q, et al. Predictive indicators of severe COVID-19 independent of comorbidities and advanced age: a nested case-control study. Epidemiol Infect. 2020 Oct 14;148:e255. PMCID: PMC7642916
41. Zhu Z, Cai T, Fan L, et al. Clinical value of immune-inflammatory parameters to assess the severity of coronavirus disease 2019. International Journal of Infectious Diseases. 2020 Jun;95:332–339.
42. Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med. 2021;89(1):1–7. PMID: 33471350
43. Arvind V, Kim JS, Cho BH, Geng E, Cho SK. Development of a machine learning algorithm to predict intubation among hospitalized patients with COVID-19. Journal of Critical Care. 2021 Apr;62:25–30.
44. Zirpe KG, Gurav SK, Tiwari AM, et al. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian Journal of Critical Care Medicine. 2021 Jul 6;25(5):493–498.
45. Langford BJ, So M, Raybardhan S, et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clinical Microbiology and Infection. 2021 Apr;27(4):520–531.
46. Kumar G, Patel D, Hererra M, et al. Do High Dose Corticosteroids Improve Outcomes in Hospitalized COVID‐19 Patients? J Med Virol. 2021 Sep 24;jmv.27357.
47. Maskin LP, Olarte GL, Palizas F, et al. High dose dexamethasone treatment for Acute Respiratory Distress Syndrome secondary to COVID-19: a structured summary of a study protocol for a randomised controlled trial. Trials. 2020 Dec;21(1):743.