Mechanical ventilation utilization in COVID-19: A systematic review and meta-analysis

Abstract

Background: In December 2019, SARS-CoV-2 caused a global pandemic with a viral infection called COVID-19. The disease usually causes respiratory symptoms but in a small proportion of patients can lead to pneumonitis, Adult Respiratory Distress Syndrome and death. Invasive Mechanical Ventilation (IMV) is considered a life-saving treatment for COVID-19 patients and a huge demand for IMV devices was reported globally. This review aims to provide insight on the initial IMV practices for COVID-19 patients in the initial phase of the pandemic. Methods: Electronic databases (Embase and MEDLINE) were searched for applicable articles using relevant keywords. The references of included articles were hand searched. Articles that reported the use of IMV in adult COVID-19 patients were included in the review. The NIH quality assessment tool for cohort and cross-sectional studies was used to appraise studies. Results: 106 abstracts were identified from the databases search, of which 16 were included. 4 studies were included in the meta-analysis. In total, 9988 patients were included across all studies. The overall cases of COVID-19 requiring IMV ranged from 2-75%. Increased age and pre-existing comorbidities increased the likelihood of IMV requirement. The reported mortality rate in patients receiving IMV ranged between 50-100%. On average, IMV was required and initiated between 10-10.5 days from symptoms onset. When invasively ventilated, COVID-19 patients required IMV for a median of 10-17 days across studies. Little information was provided on ventilatory protocols or management strategies and was inconclusive. Conclusion: In these initial reporting studies for the first month of the pandemic, patients receiving IMV were older and had more pre-existing co-morbidities than those who did not require IMV. The mortality rate was high in COVID-19 patients who received IMV. Studies are needed to evaluate protocols and modalities of IMV to improve outcomes and identify the populations most likely to benefit from IMV.

COVID-19 ICU and mechanical ventilation patient characteristics and outcomes - A systematic review and meta-analysis

“…We found a pooled mean ICU LoS of 7.8 (7-8.5) days comparable to results from a review reporting a median LoS of 8 (5-13) days for patients from China and 7 (4-11) days from outside China [44]. As for IMV duration, we found a pooled mean duration of 10 days (95% CI 7-13), which is shorter than earlier reports from Wuhan and Seattle of 10-17 days [41].…”

“…This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU cases and outcomes to date to our knowledge. Many reviews explored COVID-19 prognosis, with some reporting generally on all [36] or hospitalized cases [37], or from a certain region [38], or focused on specific aspects such as mortality [39] or outcomes [40], with only one systematic review specifically addressing IMV mortality [41]. Here we attempt to provide a comprehensive assessment of ICUadmitted COVID-19 patient characteristics, regional discrepancies, as well as overall ICU and IMV specific outcomes and their associated factors.…”

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

“…We found a pooled mean ICU LoS of 7.8 (7 to 8.5) days comparable to results from a review reporting a median LoS of 8 (5 to 13) days for patients from China and 7 (4 to 11) days from outside China [44]. As for IMV duration, we found a pooled mean duration of 10 days (95% CI 7 to 13), which is shorter than earlier reports from Wuhan and Seattle of 10 to 17 days [41].…”

“…This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU cases and outcomes to date to our knowledge. Many reviews explored COVID-19 prognosis, with some reporting generally on all [36] or hospitalized cases [37], or from a certain region [38], or focused on speci c aspects such as mortality [39] or outcomes [40], with only one systematic review speci cally addressing IMV mortality [41]. Here we attempt to provide a comprehensive assessment of ICU-admitted COVID-19 patient characteristics, regional discrepancies, as well as overall ICU and IMV speci c outcomes and their associated factors.…”

Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control

“… 1 The ICU mortality however, is 39% and 50–100% in patients requiring invasive mechanical ventilation. 2 , 3 The pandemic of this nature obviously caused medical world frenzied with multitude of expert opinions, consensus statements, and guidelines on the management of critically ill COVID-19 patients in the last few months. Lungs are the primary target organ for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the acute respiratory distress syndrome (ARDS) due to severe pneumonia is the most common cause of ICU admission.…”