Respiratory supports of COVID-19 patients in intensive care unit: A systematic review

Introduction: We aimed to describe the respiratory supports and determine their association with clinical outcomes of COVID-19 patients in intensive care unit (ICU). Methods: A systemic literature search was conducted in PubMed, EMBASE, MedRxiv and BioRxiv database from December 2019 to 2 July 2020. Studies reporting the application of respiratory supports in COVID-19 patients admitted to ICU were included. Results: Forty studies with 15320 COVID-19 patients were included in this systematic review. The proportion of invasive mechanical ventilation (IMV) application in ICU patients with COVID-19 was 73.8%. Further analysis elucidated that the use rate of IMV in Asia, Europe and North America was 47%, 76.2% and 80.2%, respectively. The proportion of patients treated with prone positioning and IMV was 29.4%. 25.5% of COVID-19 patients requiring IMV developed ventilator-associated pneumonia. The mortality of patients treated with IMV was 51.1%, while only 17.5% of critically ill COVID-19 patients treated with non-IMV respiratory support died. Additionally, the utilization rate of IMV in non-survival patients was shown 17.26-folds (95%CI 2.89-103.24, p = 0.002) higher than that in survival patients, while the use rate of ECMO was no significant difference. Conclusions: Our findings highlight respiratory supports of COVID-19 patients admitted to ICU in different continents. IMV is a life-saving strategy for critically ill COVID-19 patients with ARDS, yet the mortality remains very high.