Update Alert: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19
Authors: Bram Rochwerg, Karla Solo, Andrea Darzi, Guang Chen, Assem M. Khamis
Journal: Annals of Internal Medicine (2020)

Letters31 July 2020Update Alert: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19FREEBram Rochwerg, MD, MSc, Karla Solo, MSc, Andrea Darzi, MD, MPH, Guang Chen, MD, PhD, and Assem M. Khamis, MD, and COVID-19 Systematic Urgent Review Group Effort (SURGE) Study Authors*Bram Rochwerg, MD, MScMcMaster University, Hamilton, Ontario, Canada (B.R., K.S., A.D.), Karla Solo, MScMcMaster University, Hamilton, Ontario, Canada (B.R., K.S., A.D.), Andrea Darzi, MD, MPHMcMaster University, Hamilton, Ontario, Canada (B.R., K.S., A.D.), Guang Chen, MD, PhDBeijing University of Chinese Medicine, Beijing, China (G.C.), and Assem M. Khamis, MDUniversity of Hull, Hull, United Kingdom (A.M.K.), and COVID-19 Systematic Urgent Review Group Effort (SURGE) Study Authors*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0944 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The end date for this most recent search update for our living systematic review (1) is 7 June 2020. We found 6 new citations that met eligibility for inclusion in our review addressing noninvasive mechanical ventilation for individuals with acute hypoxic respiratory failure caused by coronavirus (coronavirus disease 2019 [COVID-19], Middle East respiratory syndrome, and severe acute respiratory syndrome) (2–7). Five are cohort studies (2, 4, 5–7), and one is a randomized controlled trial (RCT) (4) (Supplement Tables 1 and 2). The RCT, which had some concerns regarding risk of bias, compared high-flow nasal cannula (HFNC) with standard oxygen therapy in 74 patients with COVID-19 (4). Use of HFNC was associated with a reduction in the need for invasive mechanical ventilation and improvements in oxygenation compared with standard oxygen therapy. Of the 5 cohort studies, 1 compared HFNC with invasive mechanical ventilation (3), 1 compared bilevel noninvasive ventilation with standard oxygen therapy (7), 1 compared bilevel noninvasive ventilation with both invasive mechanical ventilation and standard oxygen therapy (6), 1 compared bilevel noninvasive ventilation with HFNC (5), and 1 compared bilevel noninvasive ventilation with invasive mechanical ventilation (2). All of the cohort studies had moderate risk of bias, with Ottawa–Newcastle scores of 6 to 7. Two of them included fewer than 10 patients with such a low number of events that trustworthy conclusions were not possible (3, 5). The other cohort studies did not report many of our outcomes of interest; when they did, there was no important difference between groups.In summary, the most informative new study included in this update, an RCT done by Li and colleagues (4), demonstrated results consistent with our current understanding that the use of HFNC compared with standard oxygen therapy may decrease the need for invasive mechanical ventilation in patients with COVID-19.References1. Schünemann HJ, Khabsa J, Solo K, et al. Ventilation techniques and risk for transmission of coronavirus disease, including COVID-19: a living systematic review of multiple streams of evidence. Ann Intern Med. 2020;173:204-16. [PMID: 32442035]. doi:10.7326/M20-2306 LinkGoogle Scholar2. Zheng Y, Sun LJ, Xu M, et al. Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China. J Zhejiang Univ Sci B. 2020;21:378-387. [PMID: 32425003] doi:10.1631/jzus.B2000174 CrossrefMedlineGoogle Scholar3. Hong Y, Li J, Zhao G, et al. Clinical diagnosis and prognosis analysis of severe patients with novel coronavirus pneumonia. Ningxia Med J. 2020;42:337-9. Google Scholar4. Li M, Kai C, Han H, et al. Effect of transnasal high-flow humidifying oxygen therapy for the treatment of new coronavirus pneumonia with acute respiratory failure. Chinese Journal of Coal Industry Medicine. 2020;23:221-4. Google Scholar5. Tang J, Lu J, Liu X, et al. Integrated nursing of traditional Chinese and Western medicine for 7 elderly patients with severe new coronavirus pneumonia complicated with gastrointestinal dysfunction. Chinese General Practice Nursing. 2020;18:1339-41. Google Scholar6. Shang J, Du R, Lu Q, et al. The treatment and outcomes of patients with Covid-19 in Hubei, China: a multicentered, retrospective, observational study. SSRN. Preprint posted online 3 March 2020. doi:10.2139/ssrn.3546060 Google Scholar7. Oranger M, Gonzalez-Bermejo J, Dacosta-Noble P, et al. Continuous positive airway pressure to avoid intubation in SARS-CoV-2 pneumonia: a two-period retrospective case-control study [Letter]. Eur Respir J. 2020. [PMID: 32430410] doi:10.1183/13993003.01692-2020 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Bram Rochwerg, MD, MSc; Karla Solo, MSc; Andrea Darzi, MD, MPH; Guang Chen, MD, PhD; Assem M. Khamis, MDAffiliations: McMaster University, Hamilton, Ontario, Canada (B.R., K.S., A.D.)Beijing University of Chinese Medicine, Beijing, China (G.C.)University of Hull, Hull, United Kingdom (A.M.K.)Disclaimer: The systematic review was commissioned and in part paid for by the World Health Organization. The authors alone are responsible for the views expressed in this article, which do not necessarily represent the decisions, policy, or views of the World Health Organization.Financial Support: By the World Health Organization.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0944.Corresponding Authors: Holger J. Schünemann, MD, PhD, MSc, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, HSC-2C, 1280 Main Street West, Hamilton, ON L8N 3Z5, Canada (e-mail, schuneh@mcmaster.ca), and Elie A. Akl, MD, MPH, PhD, Clinical Research Institute and AUB GRADE Center, American University of Beirut, PO Box 11-0236/CRI (E15), Riad-El-Solh Beirut, 1107 2020 Beirut, Lebanon (e-mail, ea32@aub.edu.lb).This article was published at Annals.org on 31 July 2020.* SURGE Study Authors include Ewa Borowiack, MSc; Gian Paolo Morgano, MSc; Anisa Hajizadeh, MPH; Chen Chen, MM; Hong Zhao, PhD; Tamara Lotfi, MD, MPH; Leila Harrison, MPH; Finn Schünemann, MD; Antonio Bognanni, MD; Rebecca Thomas, MPH, MBChB; Rosa Stalteri, BSHc; Anna Bak, PharmD; Marge Reinap, MA; Joanne Khabsa, MPH; Layal Hneiny, MPH, MLIS; Elie A. Akl, MD, MPH, PhD; and Holger J. Schünemann, MD, PhD, MSc. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoVentilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19 Holger J. Schünemann , Joanne Khabsa , Karla Solo , Assem M. Khamis , Romina Brignardello-Petersen , Amena El-Harakeh , Andrea Darzi , Anisa Hajizadeh , Antonio Bognanni , Anna Bak , Ariel Izcovich , Carlos A. Cuello-Garcia , Chen Chen , Ewa Borowiack , Fatimah Chamseddine , Finn Schünemann , Gian Paolo Morgano , Giovanna E.U. Muti-Schünemann , Guang Chen , Hong Zhao , Ignacio Neumann , Jan Brozek , Joel Schmidt , Layal Hneiny , Leila Harrison , Marge Reinap , Mats Junek , Nancy Santesso , Rayane El-Khoury , Rebecca Thomas , Robby Nieuwlaat , Rosa Stalteri , Sally Yaacoub , Tamara Lotfi , Tejan Baldeh , Thomas Piggott , Yuan Zhang , Zahra Saad , Bram Rochwerg , Dan Perri , Eddy Fan , Florian Stehling , Imad Bou Akl , Mark Loeb , Paul Garner , Stephen Aston , Waleed Alhazzani , Wojciech Szczeklik , Derek K. Chu , and Elie A. Akl Update Alert 2: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19 Rebecca Thomas , Tamara Lotfi , Gian Paolo Morgano , Andrea Darzi , and Marge Reinap , and COVID-19 Systematic Urgent Review Group Effort (SURGE) Study AuthorsUpdate Alert 3: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19 Giovanna Elsa Ute Muti-Schüenemann , Wojciech Szczeklik , Karla Solo , Joanne Khabsa , Rebecca Thomas , Ewa Borowiack , Assem M. Khamis , Layal Hneiny , Andrea Darzi , Leila Harrison , Anna Bak , Antonio Bongnanni , Gian Paolo Morgano , Rosa Stalteri , Anisa Hajizadeh , Tamara Lotfi , Marge Reinap , Bram Rochwerg , Elie A. Akl , Holger J. Schünemann Metrics Cited byProposed triggers for retiring a living systematic reviewThe optimal management of the patient with COVID‐19 pneumonia: HFNC, NIV/CPAP or mechanical ventilation?Airway management in the adult patient with COVID-19: High flow nasal oxygen or not? A summary of evidence and local expert opinionCOVID-19 treatment combinations and associations with mortality in a large multi-site healthcare systemPredictors for inpatient mortality during the first wave of the SARS-CoV-2 pandemic: A retrospective analysisUpdate Alert 2: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19Rebecca Thomas, MPH, MBChB, Tamara Lotfi, MD, MPH, Gian Paolo Morgano, MSc, Andrea Darzi, MD, MPH, and Marge Reinap, MA, and COVID-19 Systematic Urgent Review Group Effort (SURGE) Study Authors 15 September 2020Volume 173, Issue 6 Page: W122 Keywords Cohort studies COVID-19 Disclosure Global health Grading of Recommendations Assessment Development and Evaluation Noninvasive ventilation Oxygen Systematic reviews Ventilators ePublished: 31 July 2020 Issue Published: 15 September 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...