Dejan Radovanovic1, Pierachille Santus1,2, Silvia Coppola3, Marina Saad1,2, Stefano Pini1,2, Fabio Giuliani1, Michele Mondoni4,5, Davide A Chiumello6,5,7. 1. Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy. 2. Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy. 3. SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy. 4. Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy. 5. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy. 6. SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy - davide.chiumello@unimi.it. 7. Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milano, Italy.
Abstract
INTRODUCTION: To date, a shared international consensus on treatment of Coronavirus Disease 2019 (COVID-19) with invasive or non-invasive respiratory support is lacking. Patients' management and outcomes, especially in severe and critical cases, can vary depending on regional standard operating procedures and local guidance. EVIDENCE ACQUISITION: Rapid review methodology was applied to include all the studies published on PubMed and Embase between December 15th 2019 and February 28th 2021, reporting in-hospital and respiratory support-related mortality in adult patients hospitalized with COVID-19 that underwent either continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). Only English language studies with ≥100 patients and reporting data on respiratory failure were included. Data on comorbidities, ventilatory parameters and hospital-related complications were registered. EVIDENCE SYNTHESIS: Fifty-two studies (287359 patients - 57.5% males, mean age 64 years (range 24-98)) from 17 different countries were included in the final analysis. 33.3% of patients were hospitalized in intensive care units. 44.2% had hypertension, 26.1% had diabetes, and 7.1% a chronic respiratory disease. 55% of patients underwent respiratory support (36% IMV, 62% NIV and 2% CPAP). Without considering a study with the highest number of patients treated with NIV (n=96729), prevalence of NIV and CPAP use was 12.5% and 13.5% respectively. Globally, invasive and non-invasive approaches were heterogeneously applied. In-hospital mortality was 33.7%, and IMV-related mortality was 72.6% (range: 4.3%-99%). Specific mortality in patients treated with CPAP or NIV was available for 53% of studies, and was 29% (range: 7.2%-100%). The median length of hospital stay was 13 days (range: 6-63). The most frequent hospital-related complication was acute kidney injury being reported in up to 55.7% of enrolled patients. CONCLUSIONS: Global employment of respiratory supports and related outcomes are very heterogeneous. The most frequent respiratory support in patients with COVID-19 pneumonia is IMV, while NIV and CPAP are less frequently and equally applied, the latter especially in Europe, while data on NIV/CPAP-related mortality is often under-reported. Integrated and comprehensive reporting is desirable and needed to construct evidence-based recommendations.
INTRODUCTION: To date, a shared international consensus on treatment of Coronavirus Disease 2019 (COVID-19) with invasive or non-invasive respiratory support is lacking. Patients' management and outcomes, especially in severe and critical cases, can vary depending on regional standard operating procedures and local guidance. EVIDENCE ACQUISITION: Rapid review methodology was applied to include all the studies published on PubMed and Embase between December 15th 2019 and February 28th 2021, reporting in-hospital and respiratory support-related mortality in adult patients hospitalized with COVID-19 that underwent either continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). Only English language studies with ≥100 patients and reporting data on respiratory failure were included. Data on comorbidities, ventilatory parameters and hospital-related complications were registered. EVIDENCE SYNTHESIS: Fifty-two studies (287359 patients - 57.5% males, mean age 64 years (range 24-98)) from 17 different countries were included in the final analysis. 33.3% of patients were hospitalized in intensive care units. 44.2% had hypertension, 26.1% had diabetes, and 7.1% a chronic respiratory disease. 55% of patients underwent respiratory support (36% IMV, 62% NIV and 2% CPAP). Without considering a study with the highest number of patients treated with NIV (n=96729), prevalence of NIV and CPAP use was 12.5% and 13.5% respectively. Globally, invasive and non-invasive approaches were heterogeneously applied. In-hospital mortality was 33.7%, and IMV-related mortality was 72.6% (range: 4.3%-99%). Specific mortality in patients treated with CPAP or NIV was available for 53% of studies, and was 29% (range: 7.2%-100%). The median length of hospital stay was 13 days (range: 6-63). The most frequent hospital-related complication was acute kidney injury being reported in up to 55.7% of enrolled patients. CONCLUSIONS: Global employment of respiratory supports and related outcomes are very heterogeneous. The most frequent respiratory support in patients with COVID-19 pneumonia is IMV, while NIV and CPAP are less frequently and equally applied, the latter especially in Europe, while data on NIV/CPAP-related mortality is often under-reported. Integrated and comprehensive reporting is desirable and needed to construct evidence-based recommendations.
Authors: Terry Lee; Matthew P Cheng; Donald C Vinh; Todd C Lee; Karen C Tran; Brent W Winston; David Sweet; John H Boyd; Keith R Walley; Greg Haljan; Allison McGeer; François Lamontagne; Robert Fowler; David Maslove; Joel Singer; David M Patrick; John C Marshall; Kevin D Burns; Srinivas Murthy; Puneet K Mann; Geraldine Hernandez; Kathryn Donohoe; Genevieve Rocheleau; James A Russell Journal: CMAJ Open Date: 2022-04-19