On the Severity of COVID-19 in Intensive Care and the Role of Invasive Ventilation: A Proportion Meta-Analysis

Coronavirus Disease 2019 (COVID-19) is an emerging infectious pandemic,which has led to a worldwide public health emergency. The clinical spectrum of COVID-19 is varied, and has been explored in many studies. there is still a need to quantify the extent of the risk of developing the severe clinical manifestations of COVID-19 that require admission to intensive care unit (ICU) and mechanical ventilation initiation. The present study aims to assess ICU admission among COVID-19 confirmed cases and those who required invasive mechanical ventilation. MEDLINE, Web of Science, and SCOPUS electronic databases were searched for epidemiological studies on confirmed cases of COVID-19 atthe end of April 2020. Eligible articles that reported on admission to ICUs and mechanical ventilation were included. A random-effects model was used to pool results. A total of 23 articles reported on a total of 6124 confirmed COVID-19 cases. The majority of included articles were from China. The proportion of all hospitalized patients with confirmed COVID-19 who required ICU admission was between 0.01% to 53%, with the pooled proportion of 18% (95%CI 22,73%, I2 = 97.2%, p<0.001). The pooled proportion of ICU patients who had required invasive mechanical ventilation ranged from 4% to 94%, with the pooled estimate at 34%(95%CI 24 to 44%, I2 = 99%,p<0.001) Around a fifth of patients with confirmed COVID-19 diagnoses required admission to the ICU, and at least a third of those cases needed invasive mechanical ventilation. Still, there is a need for additional research with careful study design to identify the predictors and pathogenesis of severe cases.