The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

A total of 12 studies, involving 8,944 critically ill patients with COVID-19, were included.

All 12 studies provided data on all-cause mortality. No statistical heterogeneity was detected (I2 = 0%).

There was no statistically detectable difference between patients undergoing early versus late intubation regarding all-cause mortality.

This was also the case for duration of mechanical ventilation (1,892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65).

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