Background
Methods
Protocol and registration
Eligibility criteria
Type of studies
Type of participants
Types of interventions and comparators
Type of outcomes
Information sources
Search
Study selection
Data collection process
Data items
Geometry of the network
Risk of bias within individual studies
Planned methods of analyses
Direct comparison meta-analysis
Network comparison meta-analysis
Data synthesis
Ranking
Assessment of inconsistency
Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) assessments of the certainty of evidence for each network comparison
Additional analysis
Results
Study selection
Presentation of network structure and summary of network geometry
Source | Funding | Total No. of patients | Main cause for respiratory failure | No. of immunocompromised patients, n (%) | Age, year | P/F ratio | RR, /min | PaCO2, mmHg | Main exposure | Interface, NIV mode | Comparator | Outcomes of interest assessed | Timing of measurement for mortality |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Wysock [31] | Undisclosed | 41 | Mixed ARF (CAP 39.0%, CPO 34.1%) | NA | 63 | 207 | 35 | 43 | Non-invasive ventilation (N = 21) | Face mask, pressure support | Standard oxygen (N = 20) | Mortality, intubation | ICU discharge |
Antolnelli [49] | Undisclosed | 64 | Mixed ARF (ARDS 25.0%, atelectasis 25.0%, CPO 18.8%) | 0 (0) | 54 | 120 | 39 | 40 | Non-invasive ventilation ( N = 32) | Face mask, pressure support | Invasive ventilation, tidal volume 10 ml/kg (N = 32) | Mortality | Hospital discharge |
Confalonieri [32] | Undisclosed | 56 | CAP | NA | 64 | 175 | 37 | 49 | Non-invasive ventilation ( N = 28) | Face mask, pressure support | Standard oxygen (N = 28) | Mortality, intubation | 2-month |
Antonelli [33] | Undisclosed | 40 | Mixed ARF (ARDS 37.5%, atelectasis 25.0%, CPO 22.5%) | 40 (100) | 67 | NA | NA | 40 | Non-invasive ventilation (N = 20) | Face mask, pressure support | Standard oxygen (N = 20) | Mortality, intubation | Hospital discharge |
Delcaux [40] | Vital Signs Inc | 123 | Mixed ARF (CAP 42.3%)a | NA | 58b | 144a | 33 | 36b | Non-invasive ventilation (N = 62) | FACE mask, CPAP | Standard oxygen (N = 61) | Mortality, intubation | Hospital discharge |
Martin [41] | Undisclosed | 61 | Mixed ARF (non-COPD disease 62.3%) | NA | 61 | 199 | 28 | 57 | Non-invasive ventilation (N = 32) | Nasal mask, CPAP | Standard oxygen (N = 29) | Mortality, intubation | ICU discharge |
Hilbert [34] | Undisclosed | 52 | CAP | 52 (100) | 49 | 139 | 36 | 38 | Non-invasive ventilation (N = 26) | Face mask, pressure support | Standard oxygen (N = 26) | Mortality, intubation | Hospital discharge |
Ferrer [35] | Red GIRA, Red Respira, and Carburos Metalicos SA | 105 | Mixed ARF (CAP 32.4%, CPO 28.6%, ARDS 14.3%) | 19 (18.1) | 62 | 103 | 37 | 37 | Non-invasive ventilation (N = 51) | Face mask, pressure support | Standard oxygen (N = 54) | Mortality, intubation | ICU discharge |
Cosentini [42] | Undisclosed | 47 | CAPc | 0 (0) | 69 | 248 | 27 | 35 | Non-invasive ventilation (N = 20) | Helmet, CPAP | Standard oxygen (N = 27) | Mortality, intubation | Hospital discharge |
Squadrone [43] | Regione Piemonte (CEP AN RAN 07) and Ministero dell’Università (PRIN RANI 07) | 40 | Mixed ARFc | 40 (100) | 49 | 269 | 30 | 36 | Non-invasive ventilation (N = 20) | Helmet, CPAP | Standard oxygen (N = 20) | Mortality, intubation | Hospital discharge |
Wermke [36] | Undisclosed | 86 | CAPc | 86 (100) | 52b | 270 | NA | NA | Non-invasive ventilation (N = 42) | Face mask, pressure support | Standard oxygen (N = 44) | Mortality, intubation | 100 days |
Zhan [37] | Beijing Municipal Science and Technology Commission Program | 40 | ALI | 11 (27.5) | 46 | 230 | 20 | 32 | Non-invasive ventilation (N = 21) | Face mask, pressure support | Standard oxygen (N = 19) | Mortality, intubation | Hospital discharge |
Brambilila [44] | RCCS Fondazione Ca’Granda, Ospedale Maggiore Policlinico, Milan | 81 | CAPc | 26 (32.1) | 67 | 141 | 34 | 33 | Non-invasive ventilation (N = 40) | Helmet, CPAP | Standard oxygen (N = 41) | Mortality, intubation | Hospital discharge |
Azevedo [52] | Undisclosed | 30 | Mixed ARF (CPO 43.3%, CAP 33.3%) | NA | 67 | NA | NA | NA | Non-invasive ventilation (N = 16) | Face mask, pressure support | High-flow nasal oxygen (N = 14) | Intubation | ICU discharge |
Frat [7] | French Ministry of Health | 310 | Mixed ARF (CAP 63.5%)c | 82 (26.5) | 60 | 155 | 33 | 35 | Non-invasive ventilation (N = 110) | Face mask, pressure suppose | High-flow nasal oxygen (N = 106); standard oxygen (N = 94) | Mortality, intubation | 90 days |
Lamiale [45] | Fisher & Paykel | 100 | Mixed ARF (sepsis related 50%, CPO 7.0%) | 100 (100) | 62 | 114 | 27 | NA | High-flow nasal oxygen (N = 52) | – | Standard oxygen (N = 48) | Intubation | ICU discharge |
Lemiale [38] | Legs Poix (Chancellerie des Universités de Paris) and OUTCOMEREA Study Group | 374 | Mixed ARF (Pneumonia 68.7%)c | 374 (100) | 63b | 142 | 26 | NA | Non-invasive ventilation (N = 191) | Face mask, pressure support | Standard oxygen (N = 183) | Mortality, intubation | 28 days |
Jones [46] | Greenlane Research and Education Fund | 303 | Mixed ARF (COPD 23.9%, Pneumonia 23.8%, CPO 14.2%) | NA | 73 | NA | 33 | NA | High-flow nasal oxygen (N = 165) | – | Standard oxygen (N = 138) | Mortality, intubation | 90 days |
Muncharaz [50] | Undisclosed | 65 | Mixed ARF (CAP 63.1%, ARDS 18.5%)c | 0 (0) | 62b | 97 | 36 | 44 | Non-invasive ventilation (N = 34) | Face mask, pressure support | Invasive ventilation, tidal volume 8–10 ml/kg (PBW), Ppl < 35 (N = 31) | Mortality | Hospital discharge |
Azoulay [8] | French Ministry of Health | 776 | Mixed ARF (Pneumonia 53.0%)c | 776 (100) | 64 | 132 | 33 | NA | High-flow nasal oxygen (N = 388) | – | Standard oxygen (N = 388) | Mortality, intubation | 90 days |
He [39] | National Natural Science Foundation of China | 200 | ARDS due to CAP | 19 (9.5) | 55 | 231 | 25 | 34 | Non-invasive ventilation (N = 102) | Face mask, pressure support | Standard oxygen (N = 98) | Mortality, intubation | Hospital discharge |
Andino [47] | Spanish Ministry of Health, Social Services, and Equality | 46 | Mixed ARF (CAP 30%, HAP 26%)c | NA | 60 | 96 | 32 | 34.3 | High-flow nasal oxygen (N = 24) | Standard oxygen (N = 22) | Mortality, intubation | Hospital discharge | |
Awadallah [51] | None | 52 | ARDS | NA | 52 | 94.5 | NA | 33 | Non-invasive ventilation (N = 26) | Face mask, pressure support | Invasive ventilation, tidal volume 6–7 ml/kg (PBW), Ppl < 30 (N = 26) | Mortality | Hospital discharge |
Grieco [53] | 2017 Merck Sharp & Dohme SRL award | 109 | ARF in COVID-19 patientsc | 8 (7.3) | 65b | 102b | 28b | 34b | Non-invasive ventilation (N = 54) | Helmet, pressure support | High-flow nasal oxygen (N = 55) | Mortality, intubation | 60 days |
AlptekİnoĞlu Mendİl [48] | None | 100 | Mixed ARF (pneumonia 74%)c | 100 (100) | 59b | 262b | NA | 30b | High-flow nasal oxygen (N = 51) | Standard oxygen (N = 49) | Mortality, intubation | 28 days |
Study characteristics and risk of bias assessment
Non-invasive respiratory management strategies and risk of short-term mortality
CPAP | PSV | HFNO | IMV | SOT | |
---|---|---|---|---|---|
a. Short-term mortality | |||||
Best | 84.0% | 8.1% | 3.8% | 4.0% | 0.1% |
2nd | 9.0% | 52.6% | 23.3% | 12.1% | 3.0% |
3rd | 3.9% | 31.4% | 32.1% | 13.6% | 19.0% |
4th | 1.9% | 7.1% | 26.9% | 16.0% | 48.1% |
Worst | 1.2% | 0.8% | 13.9% | 54.3% | 29.8% |
Mean rank | 1.3 | 2.4 | 3.2 | 4.0 | 4.0 |
SUCRA | 93.2 | 65.0 | 44.1 | 23.9 | 23.9 |
CPAP | PSV | HFNO | SOT | |
---|---|---|---|---|
b. Endotracheal intubation | ||||
Best | 88.5% | 10.8% | 0.7% | 0.0% |
2nd | 8.8% | 79.0% | 12.1% | 0.1% |
3rd | 2.6% | 10.0% | 74.2% | 13.2% |
Worst | 0.1% | 0.2% | 13.0% | 86.7% |
Mean rank | 1.1 | 2.0 | 3.0 | 3.9 |
SUCRA | 95.2 | 66.8 | 33.5 | 4.5 |