Cammarota Gianmaria, Esposito Teresa, Simonte Rachele, Messina Antonio, Cecconi Maurizio, Vaschetto Rosanna, Vetrugno Luigi, Navalesi Paolo, Azzolina Danila, Robba Chiara, Pelosi Paolo, Longhini Federico, Maggiore Salvatore M, De Robertis Edoardo
From the Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy (GC, RS, EDR), Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy (TE), Humanitas Reasearch, Rozzano, Italy (AM, MC), Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy (RV), Dipartimento di Anestesiologia e Terapia Intensiva, Ospedale SS Annunziata & Dipartimento di Tecnologie Innovative in Medicina e Odontoiatria, Università Gabriele D'Annunzio di Chieti-Pescara, Chieti, Italy (LV, SMM), Dipartimento di Medina, Università degli Studi Di Padova, Padova, Italy (PN), Dipertimento di Scienze dell'Ambiente e della Prevenzione, Università degli Studi di Ferrara, Italy (DA), Dipartimento di Scienze Diagnostiche e Chirurgiche e Diagnostiche Integrate, Università di Genova, Italy (CR, PP), Anestesia e Terapia Intensiva, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy (CR, PP), Dipartimento di Scienze Mediche e Chirurgiche, Università della Magna Graecia, Catanzaro, Italy (FL).
Eur J Anaesthesiol Intensive Care. 2023 Jan 11;2(1):e0018. doi: 10.1097/EA9.0000000000000018. eCollection 2023 Feb.
Noninvasive respiratory support (NIRS) has been revealed feasible solutions to cope with the massive request for ventilatory support in patients subjected to 'do-not-intubate' order (DNI).
The aims of the present systematic review and meta-analysis was to estimate pooled incidence of DNI orders and the associated in-hospital mortality in patients undergoing NIRS for hypoxaemic acute respiratory failure (ARF) related to coronavirus disease 2019 (COVID-19).
Systematic review of observational studies and randomized-controlled trials with meta-analyses.
PUBMED, EMBASE, and Cochrane Controlled Clinical trials register were searched for observational studies and randomised-controlled trials from inception to the end of April 2022.
Inclusion criteria were: observational studies enrolling ≥50 hospitalised patients with hypoxaemic COVID-19-related ARF requiring NIRS and DNI order application. Two authors independently extracted data from enrolled investigations. Data are presented as proportions with 95% confidence interval.
Thirty-one observational studies were included for a total of 6645 COVID-19 patients undergoing NIRS, of whom 1590 received DNI orders. Among patients assisted by NIRS, a DNI order was expressed in a summary estimate of 25.4% [20.0-31.1] of the cases with a high between-study heterogeneity. The summary estimated of in-hospital mortality was 83.6% [75.3-90.7] for DNI patients and 20.0% [14.2-26.5] for full treatment patients, both with a high between-study heterogeneity.
In COVID-19 patients assisted through NIRS for hypoxaemic ARF, a DNI order was frequently issued and associated with a high in-hospital mortality.
Prospero registration number: CRD42021271313.
无创呼吸支持（NIRS）已被证明是应对接受“不插管”医嘱（DNI）患者对通气支持大量需求的可行解决方案。
本系统评价和荟萃分析的目的是估计接受NIRS治疗的2019冠状病毒病（COVID-19）相关低氧性急性呼吸衰竭（ARF）患者中DNI医嘱的合并发生率及相关的院内死亡率。
对观察性研究和随机对照试验进行系统评价并进行荟萃分析。
检索了PUBMED、EMBASE和Cochrane对照临床试验注册库，以查找从开始到2022年4月底的观察性研究和随机对照试验。
纳入标准为：观察性研究纳入≥50例因COVID-19相关低氧性ARF需要NIRS和应用DNI医嘱的住院患者。两名作者独立从纳入的研究中提取数据。数据以比例和95%置信区间表示。
纳入了31项观察性研究，共有6645例接受NIRS治疗的COVID-19患者，其中1590例接受了DNI医嘱。在接受NIRS辅助的患者中，汇总估计有25.4%[20.0-31.1]的病例表达了DNI医嘱，研究间异质性较高。DNI患者的院内死亡率汇总估计为83.6%[75.3-90.7]，全治疗患者为20.0%[14.2-26.5]，两者研究间异质性均较高。
在通过NIRS辅助治疗低氧性ARF的COVID-19患者中，经常开具DNI医嘱，且与高院内死亡率相关。
Prospero注册号：CRD42021271313。
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