Ventilation Techniques and Risk for Transmission of COVID-19

Sch√ľnemann 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;May 22:[Epub ahead of print].

The following are key points to remember from this systematic review of evidence regarding oxygenation approaches in patients with coronavirus infections:

  1. 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 were included in this review.
  2. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus.
  3. Studies evaluating risk for virus transmission to health care workers (HCWs) from aerosol-generating procedures were included.
  4. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spreads from person to person through close contact and causes coronavirus disease 2019 (COVID-19); most deaths are caused by development of hypoxemic respiratory failure and severe acute respiratory distress syndrome (ARDS).
  5. Noninvasive ventilation (NIV), invasive mechanical ventilation (IMV), and supportive therapies are the mainstays of treatment of ARDS.
  6. Although hypoxemic respiratory failure and ARDS are common in COVID-19, the ideal way of providing ventilation and the effect of NIV on HCWs is uncertain.
  7. This systematic review examined different streams of evidence, including original human studies evaluating different modalities of NIV, IMV, and high-flow oxygen by nasal cannula in COVID-19, SARS, and MERS; systematic reviews in other populations; mechanistic and laboratory evidence; and studies of aerosol-generating procedures.
  8. Together, the indirect evidence, including seven systematic reviews in other populations, suggests that NIV may reduce mortality or need for IMV, with similar effects to IMV in patients with COVID-19.
  9. However, the use of NIV and the choice of the ventilation strategy must be balanced against the potentially increased risk for infection of HCWs resulting from these aerosol-generating procedures.
  10. Clinicians should consider using NIV only when appropriate personal protective equipment is available to protect HCWs from the infection.

Clinical Topics: Prevention

Keywords: Coronavirus, Coronavirus Infections, COVID-19, Noninvasive Ventilation, Personal Protective Equipment, Primary Prevention, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Respiratory Insufficiency, Risk Assessment, SARS Virus, Severe Acute Respiratory Syndrome, severe acute respiratory syndrome coronavirus 2

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