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. 2021 May:106:254-261.
doi: 10.1016/j.ijid.2021.03.078. Epub 2021 Mar 30.

The use of non-invasive ventilation in COVID-19: A systematic review

Zhufeng Wang  1 , Yingzhi Wang  2 , Zhaowei Yang  3 , Hongkai Wu  1 , Jingyi Liang  1 , Hanwen Liang  1 , Huimin Lin  1 , Ruchong Chen  3 , Younger Ou  1 , Fengyan Wang  1 , Yuan Wang  1 , Yan Wang  1 , Weizhan Luo  1 , Naijian Li  3 , Zhengtu Li  1 , Jiaxing Xie  4 , Mei Jiang  5 , Shiyue Li  6
Affiliations

The use of non-invasive ventilation in COVID-19: A systematic review

Zhufeng Wang et al. Int J Infect Dis. 2021 May.

Abstract

Objective: Guidelines from different regions on the use of non-invasive ventilation in COVID-19 have generally been inconsistent. The aim of this systematic review was to appraise the quality and availability of guidelines, and whether non-invasive ventilation in the early stages of the pandemic is of importance.

Design and method: Databases, including PubMed, Web of Science, and Cochrane Library, as well as websites of international organizations and gray literature, were searched up to June 23, 2020. The reference lists of eligible papers were also hand-searched.

Results: A total of 26 guidelines met the inclusion criteria. According to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, the guidelines' methodological quality was low. Among six domains, Rigour of Development and Editorial Independence were of the lowest quality. Given the lack of evidence from randomized clinical trials and the great variation between different regions, recommendations for non-invasive ventilation have generated considerable debate regarding the early stages of COVID-19.

Conclusions: Improving the methodological quality of the guidelines should be a goal with regard to future pandemics. Additionally, better-designed randomized clinical trials are needed to resolve contradictions regarding the impact of non-invasive ventilation.

Prospero registration number: CRD42020198410.

Keywords: AGREE II; COVID-19; Guidelines; Non-invasive ventilation; Respiratory failure.

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Figures

Figure 1
Figure 1
Flow diagram of guidelines search and selection. *Any papers based on epidemiology, nosocomial infection, quarantine, home care, prevention, clinical manifestations, or rehabilitation, or that were focused on newborns, children, pregnant women, or the elderly were excluded.
Figure 2
Figure 2
The general characteristics of included guidelines. n (%) means the number and its proportion among 26 guidelines. Abbreviations: EB, evidence-based; GRADE, Grading of Recommendations Assessment, Development and Evaluation. #Consensus, interim guidance, recommendations, protocol.
Figure 3
Figure 3
AGREE II domain scores for all included guidelines. The larger the area, the higher the domain score.
Figure 4
Figure 4
Distribution of strength of recommendations and quality of evidence.
See this image and copyright information in PMC

References

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