European journal of anaesthesiology and intensive care · 2023
'Do-not-intubate' orders in patients assisted by noninvasive respiratory support for acute hypoxaemic failure caused by coronavirus disease 2019; a systematic review and meta-analysis.
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Cammarota Gianmaria, Esposito Teresa, Simonte Rachele, Messina Antonio, Cecconi Maurizio, Vaschetto Rosanna, Vetrugno Luigi, Navalesi Paolo, Azzolina Danila, Robba Chiara, Pelosi Paolo, Longhini Federico, Maggiore Salvatore M, De Robertis Edoardo
Аннотация
BACKGROUND: Noninvasive respiratory support (NIRS) has been revealed feasible solutions to cope with the massive request for ventilatory support in patients subjected to 'do-not-intubate' order (DNI).
OBJECTIVES: The aims of the present systematic review and meta-analysis was to estimate pooled incidence of DNI orders and the associated in-hospital mortality in patients undergoing NIRS for hypoxaemic acute respiratory failure (ARF) related to coronavirus disease 2019 (COVID-19).
DESIGN: Systematic review of observational studies and randomized-controlled trials with meta-analyses.
DATA SOURCES: PUBMED, EMBASE, and Cochrane Controlled Clinical trials register were searched for observational studies and randomised-controlled trials from inception to the end of April 2022.
ELIGIBILITY CRITERIA: Inclusion criteria were: observational studies enrolling ≥50 hospitalised patients with hypoxaemic COVID-19-related ARF requiring NIRS and DNI order application. Two authors independently extracted data from enrolled investigations. Data are presented as proportions with 95% confidence interval.
RESULTS: Thirty-one observational studies were included for a total of 6645 COVID-19 patients undergoing NIRS, of whom 1590 received DNI orders. Among patients assisted by NIRS, a DNI order was expressed in a summary estimate of 25.4% [20.0-31.1] of the cases with a high between-study heterogeneity. The summary estimated of in-hospital mortality was 83.6% [75.3-90.7] for DNI patients and 20.0% [14.2-26.5] for full treatment patients, both with a high between-study heterogeneity.
CONCLUSIONS: In COVID-19 patients assisted through NIRS for hypoxaemic ARF, a DNI order was frequently issued and associated with a high in-hospital mortality.
TRIAL REGISTRATION: Prospero registration number: CRD42021271313.
OBJECTIVES: The aims of the present systematic review and meta-analysis was to estimate pooled incidence of DNI orders and the associated in-hospital mortality in patients undergoing NIRS for hypoxaemic acute respiratory failure (ARF) related to coronavirus disease 2019 (COVID-19).
DESIGN: Systematic review of observational studies and randomized-controlled trials with meta-analyses.
DATA SOURCES: PUBMED, EMBASE, and Cochrane Controlled Clinical trials register were searched for observational studies and randomised-controlled trials from inception to the end of April 2022.
ELIGIBILITY CRITERIA: Inclusion criteria were: observational studies enrolling ≥50 hospitalised patients with hypoxaemic COVID-19-related ARF requiring NIRS and DNI order application. Two authors independently extracted data from enrolled investigations. Data are presented as proportions with 95% confidence interval.
RESULTS: Thirty-one observational studies were included for a total of 6645 COVID-19 patients undergoing NIRS, of whom 1590 received DNI orders. Among patients assisted by NIRS, a DNI order was expressed in a summary estimate of 25.4% [20.0-31.1] of the cases with a high between-study heterogeneity. The summary estimated of in-hospital mortality was 83.6% [75.3-90.7] for DNI patients and 20.0% [14.2-26.5] for full treatment patients, both with a high between-study heterogeneity.
CONCLUSIONS: In COVID-19 patients assisted through NIRS for hypoxaemic ARF, a DNI order was frequently issued and associated with a high in-hospital mortality.
TRIAL REGISTRATION: Prospero registration number: CRD42021271313.