Letters
31 July 2020

Update Alert: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19FREE

Publication: Annals of Internal Medicine
Volume 173, Number 6
An update is available for this article.
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.

Supplemental Material

Supplement. Supplement Tables

References

1.
Schünemann HJKhabsa JSolo Ket 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
2.
Zheng YSun LJXu Met 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
3.
Hong YLi JZhao Get al. Clinical diagnosis and prognosis analysis of severe patients with novel coronavirus pneumonia. Ningxia Med J. 2020;42:337-9.
4.
Li MKai CHan Het 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.
5.
Tang JLu JLiu Xet 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.
6.
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
7.
Oranger MGonzalez-Bermejo JDacosta-Noble Pet 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

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Information & Authors

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Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 173Number 615 September 2020
Pages: W122

History

Published online: 31 July 2020
Published in issue: 15 September 2020

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Authors

Affiliations

McMaster University, Hamilton, Ontario, Canada (B.R., K.S., A.D.)
McMaster University, Hamilton, Ontario, Canada (B.R., K.S., A.D.)
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.)
and COVID-19 Systematic Urgent Review Group Effort (SURGE) Study Authors
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.
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, [email protected]), 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, [email protected]).
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.

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Bram Rochwerg, Karla Solo, Andrea Darzi, et al; and COVID-19 Systematic Urgent Review Group Effort (SURGE) Study Authors . Update Alert: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19. Ann Intern Med.2020;173:W122. [Epub 31 July 2020]. doi:10.7326/L20-0944

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