The use of non-invasive ventilation in COVID-19: a systematic review

Wang, Zhufeng; Wang, Yingzhi; Yang, Zhaowei; Wu, Hongkai; Liang, Jingyi; Liang, Hanwen; Lin, Huimin; Chen, Ruchong; Ou, Younger; Wang, Fengyan; Wang, Yuan; Wang, Yan; Luo, Weizhan; Li, Naijian; Li, Zhengtu; Xie, Jiaxing; Jiang, Mei; Li, Shiyue

Objective Guidelines from different areas on the use of non-invasive ventilation in COVID-19 have generally been inconsistent. The goals were to appraise the quality and availability of guidelines stated and whether non-invasive ventilation in the early stage of the pandemic is of importance. Design and Method Databases including PubMed, Web of Science, Cochrane Library, and websites of international organizations and gray databases were searched up to June 23, 2020. We also hand-searched the reference lists of eligible papers. Results A total of 26 guidelines met the inclusion criteria. Regarding the appraisal by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, the guidelines’ methodological quality was low. Among six domains, Rigour. of Developmentand Editorial Independencewere of the lowest quality. Given the lack of evidence from randomized clinical trials and the great differences between different regions, non-invasive ventilation’s recommendations generated a considerable debate at the early stage of COVID-19. Conclusions Improving the methodological quality of the guidelines should be a goal in future pandemics. Additionally, more well-designed randomized clinical trials are needed to solve the controversy on the impact of non-invasive ventilation.