Rosanna Vaschetto1, Edoardo De Robertis2, Gianmaria Cammarota3, Teresa Esposito1, Danila Azzolina1, Roberto Cosentini4, Francesco Menzella5, Stefano Aliberti6,7, Andrea Coppadoro8, Giacomo Bellani8,9, Giuseppe Foti8,9, Giacomo Grasselli7,10, Maurizio Cecconi11,12, Antonio Pesenti7,10, Michele Vitacca13, Tom Lawton14, V Marco Ranieri15, Sandro Luigi Di Domenico16, Onofrio Resta17, Antonio Gidaro18, Antonella Potalivo19, Giuseppe Nardi19, Claudia Brusasco20, Simonetta Tesoro2, Paolo Navalesi21. 1. Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy. 2. Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, Italy. 3. Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, Italy. gmcamma@gmail.com. 4. Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy. 5. Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy. 6. Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 7. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 8. ASST Monza, San Gerardo Hospital, Monza, Italy. 9. Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 10. Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 11. Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy. 12. Department of Biomedical Sciences, Humanitas University, Milan, Italy. 13. Respiratory Rehabilitation Unit Lumezzane, ICS Maugeri IRCCS, Brescia, Italy. 14. Department of Anesthesia and Critical Care, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. 15. Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy. 16. Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 17. Cardiothoracic Department, Respiratory Unit, University Hospital, Bari, Italy. 18. Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Ospedale Luigi Sacco, Milan, Italy. 19. Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Della Romagna, Rimini, Italy. 20. Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy. 21. Department of Medicine-DIMED, Università Di Padova, Padua, Italy.
Abstract
BACKGROUND: Noninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19 patients supported by NIV outside the ICU. METHODS: We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with 'do-not-intubate' (DNI) orders. RESULTS: Seventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30-41%]. 26% [21-30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36-54%]. 23% [15-32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65-78%]. Oxygenation on admission was the main source of between-study heterogeneity. CONCLUSIONS: During COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance. REGISTRATION: PROSPERO, https://www.crd.york.ac.uk/prospero/ , CRD42020224788, December 11, 2020.
BACKGROUND: Noninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19patients supported by NIV outside the ICU. METHODS: We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with 'do-not-intubate' (DNI) orders. RESULTS: Seventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30-41%]. 26% [21-30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36-54%]. 23% [15-32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65-78%]. Oxygenation on admission was the main source of between-study heterogeneity. CONCLUSIONS: During COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance. REGISTRATION: PROSPERO, https://www.crd.york.ac.uk/prospero/ , CRD42020224788, December 11, 2020.
Authors: André Dos Santos Rocha; John Diaper; Adam L Balogh; Christophe Marti; Olivier Grosgurin; Walid Habre; Ferenc Peták; Roberta Südy Journal: Sci Rep Date: 2022-06-30 Impact factor: 4.996
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