Claudia Crimi1, Alberto Noto2,3, Andrea Cortegiani4,5, Pietro Impellizzeri6, Mark Elliott7, Nicolino Ambrosino8, Cesare Gregoretti4,9. 1. Respiratory Medicine Unit, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy - dott.claudiacrimi@gmail.com. 2. Division of Anesthesia and Intensive Care, Department of Human Pathology in Adulthood and Childhood "G. Barresi'', Policlinico G. Martino, University of Messina, Messina, Italy. 3. National Research Council, Institute for Chemical and Physical Processes, Messina, Italy. 4. Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy. 5. Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy. 6. Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania, Italy. 7. Department of Respiratory Medicine, St James's University Hospital, Leeds, UK. 8. Maugeri Clinical Scientific Institute, IRCCS Montescano Scientific Institute, Montescano, Pavia, Italy. 9. G. Giglio Foundation, Cefalù, Palermo, Italy.
Abstract
INTRODUCTION: Noninvasive respiratory support (NRS) such as noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) have been used in the treatment of acute hypoxemic respiratory failure (AHRF) related to the coronavirus disease (COVID-19) and other viral infections. However, there is a lack of consensus in favor of or against NRS use due to the risks of worsening hypoxemia, intubation delay, and aerosols environmental contamination associated with the use of these tools. We aimed to summarize the evidence on the use of NRS in adult patients with COVID-19 and other viral pneumonia (i.e. H1N1, SARS, MERS) and AHRF. We also searched for studies evaluating the risk of aerosolization/contamination with these tools. EVIDENCE ACQUISITION: We searched MEDLINE, PubMed EMBASE and two major preprint servers (biorXiv and medRxiv) from inception to April 14, 2020, for studies on the use of respiratory support in AHRF and viral pneumonia. EVIDENCE SYNTHESIS: The search identified 4086 records and we found only one randomized controlled trial out of 58 studies included, with great variabilities in support utilization and failure rates. Fifteen studies explored the issue of aerosolization/contamination showing a high risk of airborne transmission via droplets generation during the use of these modalities. CONCLUSIONS: Use of NRS and treatment failure in the context of COVID-19 and viral infection associated-AHRF, varied widely. Dispersion of exhaled air is different depending on the type of respiratory therapies and interfaces. Data from randomized controlled trials are lacking.
INTRODUCTION: Noninvasive respiratory support (NRS) such as noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) have been used in the treatment of acute hypoxemic respiratory failure (AHRF) related to the coronavirus disease (COVID-19) and other viral infections. However, there is a lack of consensus in favor of or against NRS use due to the risks of worsening hypoxemia, intubation delay, and aerosols environmental contamination associated with the use of these tools. We aimed to summarize the evidence on the use of NRS in adult patients with COVID-19 and other viral pneumonia (i.e. H1N1, SARS, MERS) and AHRF. We also searched for studies evaluating the risk of aerosolization/contamination with these tools. EVIDENCE ACQUISITION: We searched MEDLINE, PubMed EMBASE and two major preprint servers (biorXiv and medRxiv) from inception to April 14, 2020, for studies on the use of respiratory support in AHRF and viral pneumonia. EVIDENCE SYNTHESIS: The search identified 4086 records and we found only one randomized controlled trial out of 58 studies included, with great variabilities in support utilization and failure rates. Fifteen studies explored the issue of aerosolization/contamination showing a high risk of airborne transmission via droplets generation during the use of these modalities. CONCLUSIONS: Use of NRS and treatment failure in the context of COVID-19 and viral infection associated-AHRF, varied widely. Dispersion of exhaled air is different depending on the type of respiratory therapies and interfaces. Data from randomized controlled trials are lacking.
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