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Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19

Schünemann, Holger J., Khabsa, Joanne, Solo, Karla, Khamis, Assem M., Brignardello-Petersen, Romina, El-Harakeh, Amena, Darzi, Andrea, Hajizadeh, Anisa, Bognanni, Antonio, Bak, Anna, Izcovich, Ariel, Cuello-Garcia, Carlos A., Chen, Chen, Borowiack, Ewa, Chamseddine, Fatimah, Schünemann, Finn, Morgano, Gian Paolo, Muti-Schünemann, Giovanna E.U., Chen, Guang, Zhao, Hong, Neumann, Ignacio, Brozek, Jan, Schmidt, Joel, Hneiny, Layal, Harrison, Leila, Reinap, Marge, Junek, Mats, Santesso, Nancy, El-Khoury, Rayane, Thomas, Rebecca ORCID:, Nieuwlaat, Robby, Stalteri, Rosa, Yaacoub, Sally, Lotfi, Tamara, Baldeh, Tejan, Piggott, Thomas, Zhang, Yuan, Saad, Zahra, Rochwerg, Bram, Perri, Dan, Fan, Eddy, Stehling, Florian, Akl, Imad Bou, Loeb, Mark, Garner, Paul ORCID:, Aston, Stephen, Alhazzani, Waleed, Szczeklik, Wojciech, Chu, Derek K. and Akl, Elie A. (2020) 'Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19'. Annals of Internal Medicine, Vol 173, Issue 3, pp. 204-216.

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Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19).

To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. (PROSPERO registration: CRD42020178187)

Data Sources:
21 standard, World Health Organization–specific and COVID-19–specific databases, without language restrictions, until 1 May 2020.

Study Selection:
Studies of any design and language comparing different oxygenation approaches in patients with coronavirus infections, including severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), or with hypoxemic respiratory failure. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus. Studies evaluating risk for virus transmission to health care workers from aerosol-generating procedures (AGPs) were included.

Data Extraction:
Independent and duplicate screening, data abstraction, and risk of bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews).

Data Synthesis:
123 studies were eligible (45 on COVID-19, 70 on SARS, 8 on MERS), but only 5 studies (1 on COVID-19, 3 on SARS, 1 on MERS) adjusted for important confounders. A study in hospitalized patients with COVID-19 reported slightly higher mortality with noninvasive ventilation (NIV) than with invasive mechanical ventilation (IMV), but 2 opposing studies, 1 in patients with MERS and 1 in patients with SARS, suggest a reduction in mortality with NIV (very low-certainty evidence). Two studies in patients with SARS report a reduction in mortality with NIV compared with no mechanical ventilation (low-certainty evidence). Two systematic reviews suggest a large reduction in mortality with NIV compared with conventional oxygen therapy. Other included studies suggest increased odds of transmission from AGPs.

Direct studies in COVID-19 are limited and poorly reported.

Indirect and low-certainty evidence suggests that use of NIV, similar to IMV, probably reduces mortality but may increase the risk for transmission of COVID-19 to health care workers.

Item Type: Article
Subjects: WA Public Health > WA 105 Epidemiology
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
WC Communicable Diseases > Virus Diseases > General Virus Diseases > WC 500 Virus diseases (General or not elsewhere classified)
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 505 Viral respiratory tract infections
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Item titleItem URI
Update Alert 2: Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 01 Jun 2020 13:32
Last Modified: 03 Feb 2022 16:34


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