TY - JOUR
T1 - Ventilation techniques and risk for transmission of coronavirus disease, including COVID-19
T2 - A living systematic review of multiple streams of evidence
AU - Schünemann, Holger J.
AU - Khabsa, Joanne
AU - Solo, Karla
AU - Khamis, Assem M.
AU - Brignardello-Petersen, Romina
AU - El-Harakeh, Amena
AU - Darzi, Andrea
AU - Hajizadeh, Anisa
AU - Bognanni, Antonio
AU - Bak, Anna
AU - Izcovich, Ariel
AU - Cuello-Garcia, Carlos A.
AU - Chen, Chen
AU - Borowiack, Ewa
AU - Chamseddine, Fatimah
AU - Schünemann, Finn
AU - Morgano, Gian Paolo
AU - Muti-Schünemann, Giovanna E.U.
AU - Chen, Guang
AU - Zhao, Hong
AU - Neumann, Ignacio
AU - Brozek, Jan
AU - Schmidt, Joel
AU - Hneiny, Layal
AU - Harrison, Leila
AU - Reinap, Marge
AU - Junek, Mats
AU - Santesso, Nancy
AU - El-Khoury, Rayane
AU - Thomas, Rebecca
AU - Nieuwlaat, Robby
AU - Stalteri, Rosa
AU - Yaacoub, Sally
AU - Lotfi, Tamara
AU - Baldeh, Tejan
AU - Piggott, Thomas
AU - Zhang, Yuan
AU - Saad, Zahra
AU - Rochwerg, Bram
AU - Perri, Dan
AU - Fan, Eddy
AU - Stehling, Florian
AU - Akl, Imad Bou
AU - Loeb, Mark
AU - Garner, Paul
AU - Aston, Stephen
AU - Alhazzani, Waleed
AU - Szczeklik, Wojciech
AU - Chu, Derek K.
AU - Akl, Elie A.
N1 - Publisher Copyright:
© 2020 American College of Physicians
PY - 2020/8/4
Y1 - 2020/8/4
N2 - Background: Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19). Purpose: To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. Data Sources: 21 standard, World Health Organization–specific and COVID-19–specific databases, without language restrictions, until 1 May 2020. Study Selection: Studies of any design and language comparing different oxygenation approaches in patients with coronavirus infections, including severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), or with hypoxemic respiratory failure. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus. Studies evaluating risk for virus transmission to health care workers from aerosol-generating procedures (AGPs) were included. Data Extraction: Independent and duplicate screening, data abstraction, and risk-of-bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews). Data Synthesis: 123 studies were eligible (45 on COVID-19, 70 on SARS, 8 on MERS), but only 5 studies (1 on COVID-19, 3 on SARS, 1 on MERS) adjusted for important confounders. A study in hospitalized patients with COVID-19 reported slightly higher mortality with noninvasive ventilation (NIV) than with invasive mechanical ventilation (IMV), but 2 opposing studies, 1 in patients with MERS and 1 in patients with SARS, suggest a reduction in mortality with NIV (very-low-certainty evidence). Two studies in patients with SARS report a reduction in mortality with NIV compared with no mechanical ventilation (low-certainty evidence). Two systematic reviews suggest a large reduction in mortality with NIV compared with conventional oxygen therapy. Other included studies suggest increased odds of transmission from AGPs. Limitation: Direct studies in COVID-19 are limited and poorly reported. Conclusion: Indirect and low-certainty evidence suggests that use of NIV, similar to IMV, probably reduces mortality but may increase the risk for transmission of COVID-19 to health care workers.
AB - Background: Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19). Purpose: To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. Data Sources: 21 standard, World Health Organization–specific and COVID-19–specific databases, without language restrictions, until 1 May 2020. Study Selection: Studies of any design and language comparing different oxygenation approaches in patients with coronavirus infections, including severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), or with hypoxemic respiratory failure. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus. Studies evaluating risk for virus transmission to health care workers from aerosol-generating procedures (AGPs) were included. Data Extraction: Independent and duplicate screening, data abstraction, and risk-of-bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews). Data Synthesis: 123 studies were eligible (45 on COVID-19, 70 on SARS, 8 on MERS), but only 5 studies (1 on COVID-19, 3 on SARS, 1 on MERS) adjusted for important confounders. A study in hospitalized patients with COVID-19 reported slightly higher mortality with noninvasive ventilation (NIV) than with invasive mechanical ventilation (IMV), but 2 opposing studies, 1 in patients with MERS and 1 in patients with SARS, suggest a reduction in mortality with NIV (very-low-certainty evidence). Two studies in patients with SARS report a reduction in mortality with NIV compared with no mechanical ventilation (low-certainty evidence). Two systematic reviews suggest a large reduction in mortality with NIV compared with conventional oxygen therapy. Other included studies suggest increased odds of transmission from AGPs. Limitation: Direct studies in COVID-19 are limited and poorly reported. Conclusion: Indirect and low-certainty evidence suggests that use of NIV, similar to IMV, probably reduces mortality but may increase the risk for transmission of COVID-19 to health care workers.
UR - https://www.scopus.com/pages/publications/85086667647
U2 - 10.7326/M20-2306
DO - 10.7326/M20-2306
M3 - Review article
C2 - 32442035
AN - SCOPUS:85086667647
SN - 0003-4819
VL - 173
SP - 204
EP - 216
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 3
ER -