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Review
. 2021 Oct:65:1-8.
doi: 10.1016/j.jcrc.2021.05.007. Epub 2021 May 21.

Mortality and clinical outcomes in patients with COVID-19 pneumonia treated with non-invasive respiratory support: A rapid review

Dejan Radovanovic  1 , Silvia Coppola  2 , Elisa Franceschi  3 , Fabrizio Gervasoni  4 , Eleonora Duscio  5 , Davide Alberto Chiumello  6 , Pierachille Santus  3
Affiliations
Review

Mortality and clinical outcomes in patients with COVID-19 pneumonia treated with non-invasive respiratory support: A rapid review

Dejan Radovanovic et al. J Crit Care. 2021 Oct.

Abstract

Introduction and aim: Non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) have been widely employed to treat acute respiratory failure secondary to COVID-19 pneumonia, but their role in terms of efficacy and safety are still debated. The aim of this review was to analyse mortality and intubation rates in COVID-19 patients treated with NIV/CPAP.

Methods: Rapid review methodology was applied to include all the studies published since December-2019 until November-2020 with available data on in-hospital mortality in COVID-19 patients treated with NIV or CPAP.

Results: 23 manuscripts were included (4776 patients, 66% males, 46% with hypertension). 46% of patients received non-invasive respiratory support, of which 48.4% with CPAP, 46% with NIV, and 4% with either CPAP or NIV. Non-invasive respiratory support failed in 47.7% of patients, of which 26.5% were intubated and 40.9% died. In-hospital mortality was higher in patients treated with NIV compared with CPAP (35.1% vs. 22.2%). Complications were under-reported, but mostly not related to CPAP/NIV treatment.

Conclusion: CPAP and NIV appear equally and frequently applied in patients with COVID-19 pneumonia, but associated with high mortality. Robust evidence is urgently needed to confirm the clinical efficacy of non-invasive respiratory support in COVID-19-related ARDS.

Keywords: COVID-19; Continuous positive airway pressure; Intubation; Mortality; Non-invasive ventilation; Respiratory failure.

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Conflict of interest statement

The authors declare no conflicts of interest in regard to the present manuscript.

Figures

Fig. 1
Fig. 1
Flow diagram according to PRISMA guidelines showing the phases of the research process for study selection.
Fig. 2
Fig. 2
Distribution of CPAP and NIV use in the 23 studies included in the final analysis (Panel A) and mortality and intubation rate according to the non invasive respiratory support (Panel B). CPAP: continuous positive airway pressure; NIV: non invasive ventilation. * mortality from the study by Avdeev SN et al. [CITAZIONE] is not reported (17 patients) because data on mortality in patients treated with CPAP and NIV were pooled.
See this image and copyright information in PMC

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