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Mortality in mechanically ventilated patients with COVID-19: a systematic review.
Tsikala Vafea, Maria; Zhang, Raina; Kalligeros, Markos; Mylona, Evangelia K; Shehadeh, Fadi; Mylonakis, Eleftherios.
  • Tsikala Vafea M; Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Zhang R; Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Kalligeros M; Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Mylona EK; Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Shehadeh F; Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
  • Mylonakis E; Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Expert Rev Med Devices ; 18(5): 457-471, 2021 May.
Article in English | MEDLINE | ID: covidwho-1174812
ABSTRACT

Introduction:

The use of mechanical ventilation associated with acute hypoxemic respiratory failure, the most common complication in critically ill COVID-19 patients, defines a high risk population that requires specific consideration of outcomes and treatment practices.Areas covered This review evaluates existing information about mortality rates and effectiveness of antiviral, immune-modulating, and anticoagulation treatments in COVID-19 patients who received mechanical ventilation. The mortality rate and follow-up periods in patients receiving mechanical ventilation ranged widely. Antivirals, including remdesivir and convalescent plasma, have shown no definitive mortality benefit in this population despite positive results in other COVID-19 patients. Dexamethasone was associated with an absolute reduction in 28-day mortality by 12.3% (95% CI, 6.3 to 17.6), after adjusting for age. Reduced mortality has been demonstrated with tocilizumab use alongside corticosteroids. Evidence is inconclusive for therapeutic anticoagulation, and further studies are needed to determine the comparative benefit of prophylactic anticoagulation.Expert opinion Significant variation and high mortality rates in mechanically ventilated patients necessitate more standardized outcome measurements, increased consideration of risk factors to reduce intubation, and improved treatment practices. Anticoagulation and dexamethasone should be incorporated in the treatment of patients receiving invasive mechanical ventilation, while more rigorous studies are required for other potential treatments.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Cohort study / Experimental Studies / Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Expert Rev Med Devices Journal subject: Diagnostic Imaging / Therapeutics Year: 2021 Document Type: Article Affiliation country: 17434440.2021.1915764

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / COVID-19 Type of study: Cohort study / Experimental Studies / Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Expert Rev Med Devices Journal subject: Diagnostic Imaging / Therapeutics Year: 2021 Document Type: Article Affiliation country: 17434440.2021.1915764