Dataset Information

Effectiveness of non-invasive respiratory support strategies in patients with COVID-19: A systematic review and meta analysis.

ABSTRACT:

Background

BackgroundThe effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established.

Methods

A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical outcomes in patients infected with COVID-19 were considered for inclusion. End-points included all-cause mortality and risk of tracheal intubation. Evaluations were reported as risk ratios (RRs) with 95% confidence intervals (CI) and analysis was performed using a random effects model. I² index was used to assess heterogeneity.

Results

From the 1041 articles retrieved from initial search, 7 potentially relevant studies (n = 2831 patients) were included in the final analysis. Compared to conventional oxygen therapy, non-invasive respiratory strategies reduced the risk of tracheal intubation (RR = 0.84, [95% CI 0.72, 0.98]; p = 0.02, I² = 43%) and all-cause mortality (RR = 0.83, [95% CI 0.71-0.97]; p = 0.02, I² = 0%) in patients infected with COVID-19 However, reduction in length of hospital stay was not significant between the non-invasive respiratory group and conventional oxygen therapy (MD = -0.60, [95% CI -2.17 - 0.98]; p = 0.46, I² = 26%).

Conclusion

This meta-analysis supports the application of non-invasive respiratory strategy is feasible as it can delay the start of tracheal intubation and reduce mortality rates among patients infected with COVID-19.

SUBMITTER: Kumar V

PROVIDER: S-EPMC9640384 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of non-invasive respiratory support strategies in patients with COVID-19: A systematic review and meta analysis.

Kumar Vinesh V Malik Umair Arshad UA Kumari Reshman R Berkha Kumar Vijay V Kumar Manoj M Simran Suman Nasim Bushra B

Annals of medicine and surgery (2012) 20221108

<h4>Background</h4>BackgroundThe effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established.<h4>Methods</h4>A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical out ...[more]

PMID: 36411831

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Project description:BackgroundAlthough non-invasive respiratory management strategies have been implemented to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk of treatment failure. In the previous meta-analyses, the effect of non-invasive ventilation was not evaluated according to ventilation modes in those patients. Furthermore, no meta-analyses comparing non-invasive respiratory management strategies with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF.MethodsThe Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomized controlled trials (RCTs) comparing two different respiratory management strategies (continuous positive airway pressure (CPAP), pressure support ventilation (PSV), HFNO, SOT, or IMV) were reviewed.ResultsWe included 25 RCTs (3,302 participants: 27 comparisons). Using SOT as the reference, CPAP (risk ratio [RR] 0.55; 95% confidence interval [CI] 0.31-0.95; very low certainty) was associated significantly with a lower risk of mortality. Compared with SOT, PSV (RR 0.81; 95% CI 0.62-1.06; low certainty) and HFNO (RR 0.90; 95% CI 0.65-1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst (surface under the cumulative ranking curve value: 93.2, 65.0, 44.1, 23.9, and 23.9, respectively).ConclusionsWhen performing non-invasive ventilation among patients with de novo AHRF, it is important to avoid excessive tidal volume and lung injury. Although pressure support is needed for some of these patients, it should be applied with caution because this may lead to excessive tidal volume and lung injury. Trial registration protocols.io (Protocol integer ID 49375, April 23, 2021). https://doi.org/10.17504/protocols.io.buf7ntrn .

Project description:IntroductionAcute hypoxic respiratory failure (AHRF) is one of the most common causes of admission to paediatric intensive care units (PICUs) around the world, posing a serious health concern for the global community. Non-invasive respiratory support (NRS) is considered effective in reducing mortality and intubation rates in adults. However, it is not yet clear whether NRS is beneficial for children and which NRS modalities are most effective. This network meta-analysis aims to summarise existing evidence and compare the efficacy and safety of different NRS modalities in paediatric patients with acute hypoxaemic respiratory failure.Methods and analysisTo identify randomised controlled trials, we will perform a systematic search of key databases (Embase, PubMed, CENTRAL, CINAHL Complete and Web of Science) and registered clinical trials (ClinicalTrials.gov, WHO ICTRP and ISRCTN). To ensure the inclusion of the latest literature, an initial pilot search was conducted on 8 July 2024, and an updated search will be conducted after the main research work of this study. AHRF in children treated with NRS will be included. Hospital mortality, intubation rate, treatment failure rate and serious adverse events are critical outcomes closely related to patient-centredness and importance. Two authors will independently select the studies and extract the data. The risk of bias will be assessed using the Cochrane risk of bias tool V.2.0. In order to compare the effects of different NRS modalities, pairwise meta-analysis and network meta-analysis will be conducted using R software. Several subgroup analyses will be conducted, including analyses of different causes of AHRF. We will conduct sensitivity analyses by excluding studies with a high risk of bias and those involving neonates. Using the Grading of Recommendations Assessment, Development and Evaluation methodology, we will assess the certainty of the evidence for the effect estimates of all the outcomes.Ethics and disseminationSince this research is a network meta-analysis based on published literature, no formal ethics approval is required. The results will be disseminated through a peer-reviewed journal for publication.Prospero registration numberCRD42024529804.

Project description:Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen. Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16-0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19-0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29-0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects. Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.

Dataset Information

Effectiveness of non-invasive respiratory support strategies in patients with COVID-19: A systematic review and meta analysis.

Background

Methods

Results

Conclusion

Publications

Effectiveness of non-invasive respiratory support strategies in patients with COVID-19: A systematic review and meta analysis.

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