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

Zhufeng Wang; Yingzhi Wang; Zhaowei Yang; Hongkai Wu; Jingyi Liang; Hanwen Liang; Huimin Lin; Ruchong Chen; Younger Ou; Fengyan Wang; Yuan Wang; Yan Wang; Weizhan Luo; Naijian Li; Zhengtu Li; Jiaxing Xie; Mei Jiang; Shiyue Li

doi:10.1016/j.ijid.2021.03.078

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

Int J Infect Dis. 2021 May:106:254-261. doi: 10.1016/j.ijid.2021.03.078. Epub 2021 Mar 30.

Authors

Zhufeng Wang¹, Yingzhi Wang², Zhaowei Yang³, Hongkai Wu¹, Jingyi Liang¹, Hanwen Liang¹, Huimin Lin¹, Ruchong Chen³, Younger Ou¹, Fengyan Wang¹, Yuan Wang¹, Yan Wang¹, Weizhan Luo¹, Naijian Li³, Zhengtu Li¹, Jiaxing Xie⁴, Mei Jiang⁵, Shiyue Li⁶

Affiliations

¹ National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China.
² Department of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³ Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
⁴ Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. Electronic address: jiaxingxie@126.com.
⁵ National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China. Electronic address: jiangmei927@163.com.
⁶ National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China. Electronic address: lishiyue@188.com.

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.

Keywords: AGREE II; COVID-19; Guidelines; Non-invasive ventilation; Respiratory failure.

Publication types

Systematic Review

MeSH terms

COVID-19 / therapy*
Guidelines as Topic / standards*
Humans
Noninvasive Ventilation*
SARS-CoV-2