Effects of non-invasive respiratory support on gas exchange and outcomes in COVID-19 outside the ICU

Abstract

Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management.

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

“…A total of 6394 relevant studies were obtained from the databases. After excluding duplicates and evaluating the full texts of articles, we identified 23 eligible studies 9 , 11 – 32 (3 RCTs, 20 , 24 , 26 8 prospective observational studies, 13 , 16 , 18 , 19 , 22 , 25 , 28 , 30 and 12 retrospective observational studies). 9 , 11 , 12 , 14 , 15 , 17 , 21 , 23 , 27 , 29 , 31 , 32 The process of searching and screening is described in Figure 1 .…”

“…Two studies were considered to have an unclear risk of bias. The 20 observational 9 , 11 – 19 , 21 – 23 , 25 , 27 – 32 studies were assessed using the NOS checklist, and the results are shown in the Table 2 . All studies were of medium quality (⩾5 stars) or above, and 10 were considered high quality (⩾8 stars).…”

“…A total of 5354 patients participated in the 23 studies 9 , 11 – 32 of the present meta-analysis, all of whom were adult COVID-19 patients. The patients were admitted to different hospital settings and received noninvasive respiratory support at the time of admission.…”

“…The patients were admitted to different hospital settings and received noninvasive respiratory support at the time of admission. In 4 studies, 11 , 17 , 20 , 25 a helmet was applied, in 11 studies, 9 , 13 – 15 , 18 , 19 , 26 , 28 , 29 , 30 , 32 a face mask was used, 1 study 22 reported applying both a helmet and a face mask, 7 studies 12 , 16 , 21 , 23 , 24 , 27 , 31 did not report whether a helmet or a facemask was used, in 6 studies, 9 , 20 , 22 , 24 , 27 , 29 BiPAP was applied, 7 studies 11 , 17 – 19 , 25 , 26 , 30 featured CPAP, 4 studies 14 – 16 , 23 reported applying both BiPAP and CPAP, and 6 studies 12 , 13 , 21 , 28 , 31 , 32 did not report whether they applied BiPAP or CPAP ( Table 1…”

Non-invasive Respiratory Support in COVID-19: A Narrative Review

“…Interestingly, in all the hospitals that participated in the study, patients were treated in monitored areas by skilled teams. A study conducted in Ireland with a similar design compared oxygen therapy, positive pressure, and HFOT: an improvement in arterial blood gases was documented mainly in patients transitioned from oxygen to CPAP but without differences on mortality both in patients with and without DNI order ( 63 ).…”