McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.).
American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.).
Ann Intern Med. 2020 Aug 4;173(3):204-216. doi: 10.7326/M20-2306. Epub 2020 May 22.
Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19).
To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19.
21 standard, World Health Organization-specific and COVID-19-specific databases, without language restrictions, until 1 May 2020.
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.
Independent and duplicate screening, data abstraction, and risk-of-bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews).
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.
Direct studies in COVID-19 are limited and poorly reported.
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.
World Health Organization. (PROSPERO: CRD42020178187).
机械通气用于治疗 2019 年冠状病毒病（COVID-19）所致呼吸衰竭。
综述有关冠状病毒感染（包括 COVID-19）通气技术的利弊的多方面证据。
21 个标准数据库、世界卫生组织特定数据库和 COVID-19 特定数据库，无语言限制，检索时间截至 2020 年 5 月 1 日。
设计和语言各异的研究，比较了冠状病毒感染患者（包括严重急性呼吸综合征（SARS）或中东呼吸综合征（MERS）患者）或低氧性呼吸衰竭患者的不同氧合方法。收集了关于冠状病毒气溶胶扩散的动物、机制、实验室和临床前证据。纳入了评估气溶胶生成程序（AGP）对卫生保健工作者病毒传播风险的研究。
独立且重复的筛选、数据提取以及偏倚风险评估（GRADE 用于评估证据确定性，AMSTAR 2 用于评估纳入的系统评价）。
共有 123 项研究符合条件（45 项关于 COVID-19，70 项关于 SARS，8 项关于 MERS），但只有 5 项研究（1 项关于 COVID-19，3 项关于 SARS，1 项关于 MERS）调整了重要的混杂因素。一项针对 COVID-19 住院患者的研究报告称，与有创机械通气（IMV）相比，无创通气（NIV）的死亡率略高，但 2 项相反的研究（1 项针对 MERS 患者，1 项针对 SARS 患者）表明 NIV 降低了死亡率（极低确定性证据）。2 项针对 SARS 患者的研究报告称，与无机械通气相比，NIV 降低了死亡率（低确定性证据）。2 项系统评价表明，与常规氧疗相比，NIV 大大降低了死亡率。其他纳入的研究表明，AGP 增加了传播的几率。
COVID-19 的直接研究有限且报告欠佳。
间接且低确定性证据表明，与 IMV 相似，使用 NIV 可能降低死亡率，但可能增加 COVID-19 向卫生保健工作者传播的风险。
世界卫生组织（PROSPERO：CRD42020178187）。
