Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: A systematic review and meta-analysis.
Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0252760
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Moharram AA
中科院分区：
文献类型：
--
作者：
Elsayed HH;Hassaballa AS;Ahmed TA;Gumaa M;Sharkawy HY;Moharram AA
COVID 19是成人呼吸窘迫综合征ARDS的最新原因。有创机械通气IMV可以支持无创通气失败患者的气体交换，但其报告的结局在不同国家之间差异很大。我们对IMV治疗COVID相关ARDS进行了系统回顾和荟萃分析，以研究其在不同国家的结局。对CENTRAL、MEDLINE/PubMed、科克伦图书馆和Scopus进行了系统检索，检索截止日期为2020年8月8日。纳入了报告5名或更多接受IMV治疗的严重COVID 19感染患者出现终点结局的研究。评估的主要结局是死亡率。基线，程序，结果和有效性数据进行了系统评价，并与随机效应方法汇总。对不同国家进行了亚组分析。对研究时间和患者年龄的影响进行荟萃回归分析。检查了发表偏倚。本试验在PROSPERO注册，注册号为CRD 42020190365。我们的电子检索检索到4770篇引文，其中103篇被选为全文综述。共有21项研究（共计37359名COVID-19患者）符合入选标准。在这一人群中，5800例患者接受了有创机械通气治疗。其中，3301例患者在有创机械通气后达到ICU出院或死亡的终点，而其余患者仍在ICU。IMV的死亡率在纳入的研究中差异很大，范围在21%至100%之间。随机效应汇总估计值表明总体住院死亡风险比为0.70（95%置信区间为0.608至0.797; I2 = 98%）。根据来源国进行的亚组分析显示，8项中国研究具有同质性，合并死亡风险比为0.97（I2 = 24%，p = 0.23）（95% CI = 0.94 - 1.00），与意大利相似，合并死亡风险比较低，为0.26（95% CI 0.08 - 0.43）具有同质性（p = 0.86），而后来来自美国的更大规模研究显示，合并估计死亡风险比为0.60（95% CI 0.43 - 0.76），具有持续异质性（I2 = 98%，p <0.001）。荟萃回归分析显示，IMV的结局随时间推移而改善（p <0.001）。年龄对死亡率无统计学显著影响（p = 0.102）。通过可视化标准误的漏斗图、Egger检验（p = 0.714）和Begg & Mazumdar检验（p = 0.334）排除发表偏倚。该研究包括了在当前流行病中最多的IMV结局结果的患者。我们的研究结果表明，对选定的COVID 19严重ARDS患者使用IMV具有较高的死亡率，但在过去几个月和最近的研究中，结局有所改善。研究结果应鼓励医生在适用于重症COVID-19患者时使用该设施。
COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries. CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched up to August 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365. Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p = 0.23) (95% CI = 0.94–1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08–0.43) with homogeneity (p = 0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43–0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age had no statistically significant effect on mortality (p = 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger’s test with p = 0.714 and Begg&Mazumdar test with p = 0.334. The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.
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DOI：
10.1164/rccm.202006-2405oc
发表时间：
2021-01-01
影响因子：
24.7
作者：
Lim ZJ;Subramaniam A;Ponnapa Reddy M;Blecher G;Kadam U;Afroz A;Billah B;Ashwin S;Kubicki M;Bilotta F;Curtis JR;Rubulotta F
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DOI：
10.1016/0197-2456(86)90046-2
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1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
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作者：
DERSIMONIAN, R;LAIRD, N
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LAIRD, N
影响因子：
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DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
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