BY- Ishwari Deepak Nakaskar, Ganesh Vilas Rathod, Joshna Ramchandra Pawar-
Volume 1 Issue 1 (May-Aug) 2024, Article 4 (pp.29-38)
Key Points
Question: How does non-invasive ventilation compare to mechanical ventilation in reducing mortality and improving recovery in COVID-19 patients with acute respiratory failure?
Findings: In this systematic review, studies comparing non-invasive ventilation (NIV) to mechanical ventilation (MV) in COVID-19 patients with acute respiratory failure indicate that NIV is associated with lower mortality rates and improved recovery outcomes. The evidence suggests that NIV may reduce the need for invasive procedures and has a positive impact on patient recovery times.
Meaning: Non-invasive ventilation may offer a preferable alternative to mechanical ventilation for COVID-19 patients with acute respiratory failure, potentially improving survival rates and recovery outcomes.
Abstract
Importance:
The global COVID-19 pandemic has imposed unprecedented challenges on healthcare systems, particularly in managing acute respiratory failure (ARF). Effective respiratory support strategies are crucial in improving patient outcomes and reducing mortality rates. Understanding the comparative efficacy of non-invasive ventilation (NIV) and mechanical ventilation (MV) is vital for optimizing treatment approaches in critically ill COVID-19 patients.
Objective:
This systematic review aims to evaluate the impact of non-invasive ventilation compared to mechanical ventilation in reducing mortality and improving recovery outcomes among COVID-19 patients suffering from acute respiratory failure. The review focuses on identifying differences in survival rates, recovery times, and the need for invasive procedures between these two respiratory support modalities.
Evidence Review:
A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus, and Embase, covering studies published from January 2020 to July 2024. The search strategy included combinations of keywords such as “COVID-19,” “acute respiratory failure,” “non-invasive ventilation,” and “mechanical ventilation.” Inclusion criteria comprised randomized controlled trials, cohort studies, and observational studies involving adult COVID-19 patients. Study quality was assessed using validated tools such as the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale.
Findings:
A total of 22 studies met the inclusion criteria, encompassing over 15,000 COVID-19 patients. The studies included randomized controlled trials, cohort studies, and case-control studies. Evidence suggests that NIV is associated with reduced mortality rates and faster recovery times compared to MV in COVID-19 patients with ARF. Furthermore, the use of NIV was linked to a decreased need for invasive procedures, such as intubation, without compromising patient outcomes. However, the quality of evidence varied across studies, with some exhibiting a moderate to high risk of bias.
Conclusions and Relevance:
Non-invasive ventilation appears to be a more favorable option for managing acute respiratory failure in COVID-19 patients compared to mechanical ventilation. The findings suggest that NIV may reduce mortality and expedite recovery, while also mitigating the risks associated with invasive mechanical ventilation. These results support the consideration of NIV as a first-line intervention in appropriate clinical scenarios, with implications for both clinical practice and healthcare policy.
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