Division of Respiratory Diseases, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy.
Minerva Anestesiol. 2021 Aug;87(8):915-926. doi: 10.23736/S0375-9393.21.15486-0. Epub 2021 May 26.
To date, a shared international consensus on treatment of Coronavirus disease 2019 (COVID-19) with invasive or non-invasive respiratory support is lacking. Patients' management and outcomes, especially in severe and critical cases, can vary depending on regional standard operating procedures and local guidance.
Rapid review methodology was applied to include all the studies published on PubMed and Embase between December 15, 2019 and February 28, 2021, reporting in-hospital and respiratory support-related mortality in adult patients hospitalized with COVID-19 that underwent either continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). Only English language studies with ≥100 patients and reporting data on respiratory failure were included. Data on comorbidities, ventilatory parameters and hospital-related complications were registered.
Fifty-two studies (287,359 patients; 57.5% males, mean age 64 years, range 24-98 years) from 17 different countries were included in the final analysis. 33.3% of patients were hospitalized in intensive care units. 44.2% had hypertension, 26.1% had diabetes, and 7.1% a chronic respiratory disease. 55% of patients underwent respiratory support (36% IMV, 62% NIV and 2% CPAP). Without considering a study with the highest number of patients treated with NIV (N.=96,729), prevalence of NIV and CPAP use was 12.5% and 13.5% respectively. Globally, invasive and non-invasive approaches were heterogeneously applied. In-hospital mortality was 33.7%, and IMV-related mortality was 72.6% (range: 4.3-99%). Specific mortality in patients treated with CPAP or NIV was available for 53% of studies, and was 29% (range: 7.2-100%). The median length of hospital stay was 13 days (range: 6-63). The most frequent hospital-related complication was acute kidney injury being reported in up to 55.7% of enrolled patients.
Global employment of respiratory supports and related outcomes are very heterogeneous. The most frequent respiratory support in patients with COVID-19 pneumonia is IMV, while NIV and CPAP are less frequently and equally applied, the latter especially in Europe, while data on NIV/CPAP-related mortality is often under-reported. Integrated and comprehensive reporting is desirable and needed to construct evidence-based recommendations.
迄今为止，对于使用有创或无创呼吸支持治疗 2019 年冠状病毒病（COVID-19），尚未达成国际共识。患者的管理和结局，尤其是重症和危重症患者，可能因地区标准操作流程和当地指南的不同而有所差异。
采用快速综述方法，纳入 2019 年 12 月 15 日至 2021 年 2 月 28 日期间在 PubMed 和 Embase 上发表的所有研究，报告因 COVID-19 住院且接受持续气道正压通气（CPAP）、无创通气（NIV）或有创机械通气（IMV）的成年患者的院内和与呼吸支持相关的死亡率。仅纳入纳入了≥100 例患者且报告了呼吸衰竭数据的英语语言研究。登记了合并症、通气参数和医院相关并发症的数据。
最终分析纳入了来自 17 个不同国家的 52 项研究（287359 例患者；57.5%为男性，平均年龄 64 岁，范围 24-98 岁）。33.3%的患者住院于重症监护病房。44.2%有高血压，26.1%有糖尿病，7.1%有慢性呼吸系统疾病。55%的患者接受了呼吸支持（36%接受 IMV，62%接受 NIV，2%接受 CPAP）。如果不考虑一项纳入了接受 NIV 治疗的患者数量最多的研究（N=96729），则 NIV 和 CPAP 的使用率分别为 12.5%和 13.5%。全球范围内，有创和无创方法的应用存在差异。院内死亡率为 33.7%，IMV 相关死亡率为 72.6%（范围：4.3-99%）。53%的研究报告了接受 CPAP 或 NIV 治疗患者的特定死亡率，为 29%（范围：7.2-100%）。纳入研究中中位住院时间为 13 天（范围：6-63 天）。最常见的医院相关并发症是急性肾损伤，高达 55.7%的入组患者出现该并发症。
全球对呼吸支持的应用和相关结局存在很大差异。COVID-19 肺炎患者最常应用的呼吸支持是 IMV，而 NIV 和 CPAP 的应用频率较低且相当，后者尤其在欧洲，而 NIV/CPAP 相关死亡率的数据通常报告不足。综合全面的报告是可取的，也是制定循证建议所必需的。
