Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections

Abstract

Introduction: Noninvasive respiratory support (NRS) such as noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) have been used in the treatment of acute hypoxemic respiratory failure (AHRF) related to the coronavirus disease (COVID-19) and other viral infections. However, there is a lack of consensus in favor of or against NRS use due to the risks of worsening hypoxemia, intubation delay, and aerosols environmental contamination associated with the use of these tools. We aimed to summarize the evidence on the use of NRS in adult patients with COVID-19 and other viral pneumonia (i.e. H1N1, SARS, MERS) and AHRF. We also searched for studies evaluating the risk of aerosolization/contamination with these tools. Evidence Acquisition: We searched MEDLINE, PubMed EMBASE and two major preprint servers (biorXiv and medRxiv) from inception to April 14, 2020, for studies on the use of respiratory support in AHRF and viral pneumonia. Evidence Synthesis: The search identified 4086 records and we found only one randomized controlled trial out of 58 studies included, with great variabilities in support utilization and failure rates. Fifteen studies explored the issue of aerosolization/contamination showing a high risk of airborne transmission via droplets generation during the use of these modalities Conclusions: Use of NRS and treatment failure in the context of COVID-19 and viral infection associated-AHRF, varied widely. Dispersion of exhaled air is different depending on the type of respiratory therapies and interfaces. Data from randomized controlled trials are lacking.

Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

“…[16][17][18] In the setting of an ICU, different routine care tasks (e.g. non-invasively ventilated patients, high flow oxygen therapy, orotracheal intubation) may determine aerosolization, 19 thus reasonably explaining the high percentage (99%) of the surveyed HCWs using a level of protection equal to FFP2 or higher for routine care.…”

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

“…On the whole, despite the fact that non-invasive ventilation techniques (HFONC, bi-level pressure ventilation or CPAP) have already been used in several respiratory virus outbreaks (SARS, MERS, H1N1), we lack strong evidence on their efficiency because studies were mainly retrospective, with inappropriate control for selecting or confounding bias, or without any control group [30,31]. As a consequence, recommendations from scientific societies concerning non-invasive oxygen therapy in COVID-19 are heterogenous, some favouring HFONC, CPAP, or bi-level pressure, depending on the country [32].…”

Non-invasive respiratory support in the treatment of acute hypoxemic respiratory failure secondary to CoViD-19 related pneumonia

“…Dealing with a communicable disease, through the dispersion of droplets, it is essential to consider the possibility that NRS devices may represent a risk of contagion for healthcare personnel. In this field, available studies are very inhomogeneous with each other in terms of methods and results [23,32]. From what is available it can be stated that the least droplet-dispersive devices are represented by the helmet, the non-rebreathing mask and HFNC.…”