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RESEARCH PRODUCT

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

Pietro ImpellizzeriAlberto NotoAlberto NotoMark W. ElliottCesare GregorettiAndrea CortegianiClaudia CrimiNicolino Ambrosino

subject

Adultmedicine.medical_specialtyContext (language use)Diseasemedicine.disease_causeHIGH FLOW NASAL THERAPYAirborne transmissionHFNCHypoxemialaw.invention03 medical and health sciences0302 clinical medicineInfluenza A Virus H1N1 SubtypeRandomized controlled trial030202 anesthesiologylawmedicineHumansCOVID-19; Noninvasive ventilation Pneumonia viral Adult Humans Pandemics SARS-CoV-2 COVID-19 Coronavirus. Influenza A Virus H1N1 Subtype Noninvasive Ventilation Respiratory InsufficiencyH1N1 SubtypeIntensive care medicinePandemicsAerosolizationCoronavirusNoninvasive VentilationPneumonia viralSARS-CoV-2business.industryCOVID-19030208 emergency & critical care medicinemedicine.diseaseCoronavirusAnesthesiology and Pain MedicineCoronavirus. Influenza A VirusViral pneumoniamedicine.symptomRespiratory InsufficiencybusinessHFNT

description

ABSTRACTIntroductionNoninvasive 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 AcquisitionWe 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 SynthesisThe 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 modalitiesConclusionsUse 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.

yearjournalcountryeditionlanguage
2020-05-26
https://doi.org/10.1101/2020.05.24.20111013