Review
The use of non-invasive ventilation in COVID-19: A systematic review

https://doi.org/10.1016/j.ijid.2021.03.078Get rights and content
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open access

Highlights

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    The findings may augment knowledge of management strategies for COVID-19.

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    Developers should follow guideline development standards.

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    More attention should be paid to the impact of non-invasive ventilation.

Abstract

Objective

Guidelines from different regions on the use of non-invasive ventilation in COVID-19 have generally been inconsistent. The aim of this systematic review was to appraise the quality and availability of guidelines, and whether non-invasive ventilation in the early stages of the pandemic is of importance.

Design and method

Databases, including PubMed, Web of Science, and Cochrane Library, as well as websites of international organizations and gray literature, were searched up to June 23, 2020. The reference lists of eligible papers were also hand-searched.

Results

A total of 26 guidelines met the inclusion criteria. According to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, the guidelines’ methodological quality was low. Among six domains, Rigour of Development and Editorial Independence were of the lowest quality. Given the lack of evidence from randomized clinical trials and the great variation between different regions, recommendations for non-invasive ventilation have generated considerable debate regarding the early stages of COVID-19.

Conclusions

Improving the methodological quality of the guidelines should be a goal with regard to future pandemics. Additionally, better-designed randomized clinical trials are needed to resolve contradictions regarding the impact of non-invasive ventilation.

PROSPERO registration number

CRD42020198410.

Abbreviations

AGREE
Appraisal of Guidelines for Research and Evaluation
BiPAP
bilevel positive airway pressure
COVID-19
coronavirus disease 2019
CPAP
continuous positive airway pressure
FiO2
fraction of inspired oxygen
GRADE
Grading of Recommendations Assessment, Development and Evaluation
ICC
intraclass correlation coefficient
ICU
intensive care unit
NI-CPAP
non-invasive continuous positive airway pressure
NIPPV
nasal intermittent positive pressure ventilation
NIV
non-invasive ventilation
PaCO2
partial pressure of carbon dioxide in artery
PEEP
positive end-expiratory pressure
PPE
personal protective equipment
PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
SpO2
peripheral oxygen saturation
ARIR & AIFI
Italian Association of Respiratory Physiotherapists & Italian Association of Physiotherapists, Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a position paper of the Italian Association of Respiratory Physiotherapists
ASID
Australasian Society for Infectious Diseases, Interim guidelines for the clinical management of COVID-19 in adults
BTS
British Thoracic Society, Use of acute NIV in patients hospitalized with suspected or confirmed COVID-19 infection
BTS (guidance)
British Thoracic Society, Respiratory support of patients on medical wards
CCCGWG
COVID-19 Clinical Care Guidance Working Group, Clinical management of patients with moderate to severe COVID-19 — interim guidance
CTS & CACP
Chinese Thoracic Society & Chinese Association of Chest Physicians, Guidance for the management of adult patients with coronavirus disease 2019
ICSI
Intensive Care Society of Ireland, Guidance document for the intensive care management of the adult patient with confirmed or suspected COVID-19
Indian CDC
Indian Centers for Disease Control and Prevention, Guidelines on clinical management of severe acute respiratory illness (SARI) in suspect/confirmed novel coronavirus (nCoV) cases
INMI
National Institute for Infectious Diseases, National Institute for the Infectious Diseases “L. Spallanzani”, IRCCS, Recommendations for COVID-19 clinical management
ITS & IRS
Italian Thoracic Society & Italian Respiratory Society, Managing the respiratory care of patients with COVID-19
NCCET
National COVID-19 Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19
NHC & SATCM
National Health Commission & State Administration of Traditional Chinese Medicine, Diagnosis and treatment protocol for novel coronavirus pneumonia (Trial version 7)
NHS (critical care)
National Health Service, Clinical guide for the management of critical care for adults with COVID-19 during the coronavirus pandemic
NHS (NIV)
National Health Service, Guidance for the role and use of non-invasive respiratory support in adult patients with COVID-19 (confirmed or suspected)
NHS (management)
National Health Service, Clinical management of persons admitted to hospital with suspected COVID-19 infection
NIH
National Institutes of Health, Coronavirus disease 2019 (COVID-19) treatment guidelines
PAHO
Pan American Health Organization, Guidelines for critical care of seriously ill adult patients with coronavirus (COVID-19) in the Americas
PCS
Pakistan Chest Society, COVID-19 management guidelines
SIAARTI & EAMS
Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva & European Airway Management Society, The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice
SIMIT
Lombardy Section of the Italian Society of Infectious and Tropical Diseases, Guidelines for the treatment of people with COVID-19 disease, edition 2.0, 13 March 2020
SSC
Surviving Sepsis Campaign, Guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19)
SSICM
Swiss Society of Intensive Care Medicine, Recommendations for the admission of patients with COVID-19 to intensive care and intermediate care units (ICUs and IMCUs)
Kluge et al.
German recommendations for critically ill patients with COVID-19
Thomas et al.
Physiotherapy management for COVID-19 in the acute hospital setting: recommendations to guide clinical practice
WHO
World Health Organization, Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance v. 1.2
WHO-toolkit
World Health Organization, Clinical care for severe acute respiratory infection: toolkit — COVID-19 adaptation

Keywords

COVID-19
Non-invasive ventilation
Respiratory failure
Guidelines
AGREE II

Cited by (0)

1

Zhufeng Wang, Yingzhi Wang, Zhaowei Yang, and Hongkai Wu contributed equally as co-first authors.

© 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.