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2020 ; 173
(3
): 204-216
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English Wikipedia
Ventilation Techniques and Risk for Transmission of Coronavirus Disease,
Including COVID-19: A Living Systematic Review of Multiple Streams of Evidence
#MMPMID32442035
Schünemann HJ
; Khabsa J
; Solo K
; Khamis AM
; Brignardello-Petersen R
; El-Harakeh A
; Darzi A
; Hajizadeh A
; Bognanni A
; Bak A
; Izcovich A
; Cuello-Garcia CA
; Chen C
; Borowiack E
; Chamseddine F
; Schünemann F
; Morgano GP
; Muti-Schünemann GEU
; Chen G
; Zhao H
; Neumann I
; Brozek J
; Schmidt J
; Hneiny L
; Harrison L
; Reinap M
; Junek M
; Santesso N
; El-Khoury R
; Thomas R
; Nieuwlaat R
; Stalteri R
; Yaacoub S
; Lotfi T
; Baldeh T
; Piggott T
; Zhang Y
; Saad Z
; Rochwerg B
; Perri D
; Fan E
; Stehling F
; Akl IB
; Loeb M
; Garner P
; Aston S
; Alhazzani W
; Szczeklik W
; Chu DK
; Akl EA
Ann Intern Med
2020[Aug]; 173
(3
): 204-216
PMID32442035
show ga
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. PRIMARY FUNDING SOURCE: World Health Organization.
(PROSPERO: CRD42020178187).