Mechanical ventilation utilization in COVID-19: A systematic review and meta-analysis

  1. Mohammed A. Almeshari
  2. Nowaf Y. Alobaidi
  3. Mansour Al Asmri
  4. Eyas Alhuthail
  5. Ziyad Alshehri
  6. Farhan Alenezi
  7. Elizabeth Sapey
  8. Dhruv Parekh

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Abstract

Background

In December 2019, SARS-CoV-2 caused a global pandemic with a viral infection called COVID-19. The disease usually causes respiratory symptoms but in a small proportion of patients can lead to a pneumonitis, Adult Respiratory Distress Syndrome and death. Invasive Mechanical Ventilation (IMV) is considered a life-saving treatment for COVID-19 patients and a huge demand for IMV devices was reported globally. This review aims to provide insight on the initial IMV practises for COVID-19 patients in the initial phase of the pandemic.

Methods

Electronic databases (Embase and MEDLINE) were searched for applicable articles using relevant keywords. The references of included articles were hand searched. Articles that reported the use of IMV in adult COVID-19 patients were included in the review. The NIH quality assessment tool for cohort and cross-sectional studies was used to appraise studies.

Results

106 abstracts were identified from the databases search, of which 16 were included. 5 studies were included in the meta-analysis. In total, 9988 patients were included across all studies. The overall cases of COVID-19 requiring IMV ranged from 2–77%. Increased age and pre-existing comorbidities increased the likelihood of IMV requirement. The reported mortality rate in patients receiving IMV ranged between 50–100%. On average, IMV was required and initiated between 10–10.5 days from symptoms onset. When invasively ventilated, COVID-19 patients required IMV for a median of 10–17 days across studies. Little information was provided on ventilatory protocols or management strategies and were inconclusive.

Conclusion

In these initial reporting studies for the first month of the pandemic, patients receiving IMV were older and had more pre-existing co-morbidities than those who did not require IMV. The mortality rate was high in COVID-19 patients who received IMV. Studies are needed to evaluate protocols and modalities of IMV to improve outcomes and identify the populations most likely to benefit from IMV.

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  1. Version published to 10.1101/2020.06.04.20122069v4 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2020.06.04.20122069: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    BlindingStudy selection and data extraction: Abstracts were screened blindly and independently by MA and EA using the predefined inclusion and exclusion criteria.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search queries were carried out on the 23rd of April, 2020, using the search strategy shown in (additional file 1) on the following electronic databases: Embase, MEDLINE. http://Clinicaltrails.gov and EudraCT were searched for active trials or published data.
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    Full-text articles were acquired and imported into EndNote 9.1 by MA and similar abstract screening methodology was used in screening full texts for eligibility.
    EndNote
    suggested: (EndNote, RRID:SCR_014001)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.04.20122069v3 on medRxiv
  4. Version published to 10.1101/2020.06.04.20122069v2 on medRxiv
  5. Version published to 10.1101/2020.06.04.20122069v1 on medRxiv