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

Abstract

AbstractBackgroundIn 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.MethodsElectronic 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.Results106 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.ConclusionIn 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.