Risk for transmission of viral infection during treatment with non-invasive ventilation using CPAP or BiPAP

Viral infections caused by SARS-CoV-2, SARS-CoV-1 or MERS-CoV can lead to severe respiratory failure and the need for hospital care. The ventilation treatment can be invasive or non-invasive. Continuous positive airway pressure and Bi positive airway pressure (CPAP and BiPAP) are open non-invasive ventilation systems in which viral infection may be transmitted via aerosol.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202020 Registration no: SBU 2020/382

Question

What scientific studies are there on the risk for transmission of SARS-CoV-2, SARS-CoV-1 or MERS-CoV infections during treatment with non-invasive ventilation?

Method

SBU’s Enquiry Service identifies and summarizes systematic reviews or scientific studies which answer specific questions posed by decision makers and health care personnel. For this response, PubMed, Embase, Cinahl and Cochrane Library were systematically searched in March 2020. Records relevant to the question posed were identified and assessed for risk of bias by two independent persons. Systematic reviews were assessed for risk of bias using AMSTAR [1] and the identified primary studies were assessed for risk of bias using a translation of ROBINS-I [2]. This response does not attempt to weigh together or grade the reliability of the results presented.

Identified literature

We identified one relevant systematic review that had been published twice [3,4] and four primary studies [5–8]. Only two out of ten studies included in the systematic review reported results on CPAP or BiPAP. These studies were also identified in the literature search and therefore the systematic review was not tabulated [5,7]. All four primary studies were judged to have a high risk of bias from confounders and retrospective data collection.

References

  1. Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 2009;62:1013-20.
  2. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919.
  3. Tran K, Cimon K, Severn M, Pessoa-Silva C, Conly J. Aerosol generating procedures (AGP) and risk of transmission of acute respiratory diseases (ARD): A systematic review. BMC Proceedings 2011;5.
  4. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS ONE 2012;7.
  5. Fowler RA, Guest CB, Lapinsky SE, Sibbald WJ, Louie M, Tang P, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. American Journal of Respiratory & Critical Care Medicine 2004;169:1198-1202.
  6. Heinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, et al. Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient - Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:472-6.
  7. Raboud J, Shigayeva A, McGeer A, Bontovics E, Chapman M, Gravel D, et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS One 2010;5:e10717.
  8. Yu IT, Zhan HX, Tsoi KK, Yuk LC, Siu WL, Xiao PT, et al. Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others? Clinical Infectious Diseases 2007;44:1017-25.

Literature search

PubMed via NLM 200323 
Non-invasiv ventilation for patients with COVID-19, SARS or MERS
The search result, usually found at the end of the documentation, forms the list of abstracts.; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
Search terms Items found
Population:
1. “Severe Acute Respiratory Syndrome Coronavirus 2”[Supplementary Concept] 245
2. “severe acute respiratory syndrome coronavirus 2”[Title/abstract] 101
3. “2019 nCov”[Title/Abstract] 356
4. 2019nCoV[Title/Abstract] 350
5. “2019-nCov”[Title/Abstract] 973
6. CoVID-19[Title/Abstract] 973
7. CoVID19[Title/Abstract] 964
8. SARS-CoV-2[Title/Abstract] 355
9. “SARS CoV 2”[Title/Abstract] 552
10. CoVid[Title/Abstract] 983
11. nCov[Title/Abstract] 371
12. “novel coronavirus”[Title/Abstract] 994
13. “new coronavirus”[Title/Abstract] 143
14. “coronavirus 2019”[Title/Abstract] 202
15. “SARS coronavirus 2”[Title/Abstract] 4
16. 1 OR 2 OR […] 145 1956
17. “Severe Acute Respiratory Syndrome”[Mesh] 447
18. “SARS Virus”[Mesh] 2904
19. “Severe acute respiratory syndrome”[Title/Abstract] 4639
20. SARS[Title/Abstract] 8674
21. "SARS-CoV"[Title/Abstract] 2626
22. 17 OR 18 OR […] 21 10185
23. “Middle East Respiratory Syndrome Coronavirus”[Mesh] 972
24. ”Coronavirus Infections”[Mesh:NoExp] 4535
25. MERS[Title/Abstract] 4104
26. “MERS-CoV”[Title/Abstract] 1532
27. “Middle East respiratory syndrome”[Title/Abstract] 1778
28. “Middle East respiratory syndrome-related coronavirus”[Title/Abstract] 8
29. “EMC/2012” [Title/Abstract] 14
30. 23 OR 24 OR […] 29 7735
31. 16 OR 22 OR 30 17829
Intervention:
32. ”Positive‐Pressure Respiration”[MeSH] 25500
33. ”Positive pressure” [Title/Abstract] 9484
34. ”positive airway” [Title/Abstract] 11088
35 CPAP[Title/Abstract] 8166
36. “Noninvasive Ventilation”[MeSH] 1966
37. ”Noninvasive ventilation”[Title/Abstract] OR ”Non invasive ventilation”[Title/Abstract] 5183
38. “Bi LevelPAP”[Title/Abstract] 0
39. ”BiPAP” [Title/Abstract] 684
40. ”Niv” [Title/Abstract] 2996
41. “Positive end-expiratory pressure” [Title/Abstract] 5734
42. “Peep”[Title/Abstract] 5326
43. “NIPPV”[Title/Abstract] OR” NPPV”[Title/Abstract] 1076
44. “Pressure support”[Title/Abstract] OR NIPSV[Title/Abstract] 1951
45. ("Non invasive" [Title/Abstract] OR "Noninvasive" [Title/Abstract]) AND (“assisted ventilation” [Title/Abstract] OR "Mechanical ventilation"[Title/Abstract] OR “Artificial ventilation"[Title/Abstract]) 3183
46. “NIAV”[Title/Abstract] 2
47. “pressure release” [Title/Abstract] OR “aprv” [Title/Abstract] 645
48. “ippv” [Title/Abstract] 708
49. "Nasal ventilation" [Title/Abstract] 295
50. "Mask ventilation" [Title/Abstract] 1538
51. 32 OR 33 OR […] 50 46488
Final 31 AND 51 94

 

Embase via embase.com 200323 
Non-invasiv ventilation for patients with COVID-19, SARS or MERS
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population
1. ‘coronavirus disease 2019’/exp 79
2. ‘sars-related coronavirus’/de 45
3. ‘severe acute respiratory syndrome coronavirus 2’:ti,ab,kw 39
4. ‘2019-ncov’:ti,ab,kw 278
5. ‘2019ncov’:ti,ab,kw 0
6. ‘2019 ncov’:ti,ab,kw 278
7. ‘covid-19’:ti,ab,kw 398
8. ‘covid19’:ti,ab,kw 1
9. ‘sars-cov-2':ti,ab,kw 184
10. ‘covid’:ti,ab,kw 402
11. ‘ncov’:ti,ab,kw 291
12. ‘novel coronavirus’:ti,ab,kw 815
13. ‘new coronavirus’:ti,ab,kw 127
14. ‘coronavirus 2019’:ti,ab,kw 163
15. ‘sars coronavirus 2’:ti,ab,kw 2
16. 1 OR 2 OR […] 15 1 330
17. ‘severe acute respiratory syndrome’/exp 8 191
18. ‘sars coronavirus’/exp 4 636
19. ‘severe acute respiratory syndrome’:ti,ab,kw 4 960
20. ‘sars’:ti,ab,kw 9 682
21. ‘sars-cov’:ti,ab,kw 2 693
22. 17 OR 18 […] 21 13 905
23. ‘middle east respiratory syndrome coronavirus’/exp 1 864
24. ‘middle east respiratory syndrome’/exp 1 011
25. ‘mers’:ti,ab,kw 4 498
26. ‘mers-cov’:ti,ab,kw 1 679
27. ‘emc/2012’:ti,ab,kw 24
28. ‘middle east respiratory syndrome’:ti,ab,kw 1 908
29. 22 OR 23 OR […] 28 5 248
30. 16 OR 22 OR 29 18 786
Intervention:
31. ‘positive end expiratory pressure’/exp 54 706
32. ‘intermittent positive pressure ventilation’/exp 3 347
33. ‘pressure support ventilation’/exp 1 570
34. ‘noninvasive ventilation’/exp 9 381
35. ‘positive airway pressure’/exp 23
36. ‘bi level positive airway pressure’/exp 48
37. ‘cpap device’/exp 920
38. ‘bipap device’/exp 18
39. ‘intermittent positive pressure breathing machine’/exp 16
40. ‘positive expiratory pressure ventilator’/exp 309
41. ‘pressure support ventilator’/exp 20
42. ‘positive pressure’:ti,ab,kw 13 430
43. ‘positive airway’:ti,ab,kw 17 056
44. ‘cpap’:ti,ab,kw 15 980
45. ‘bi level pap’:ti,ab,kw 56
46. ‘bipap’:ti,ab,kw 1 832
47. ‘niv’:ti,ab,kw 6 247
48. ‘positive end expiratory pressure’:ti,ab,kw 7 420
49. ‘peep’:ti,ab,kw 9 175
50. ‘nippv’:ti,ab,kw 988
51. ‘nppv’:ti,ab,kw 899
52. ‘pressure support’:ti,ab,kw 3 266
53. ‘nipsv’:ti,ab,kw 43
54. ‘niav’:ti,ab,kw 6
55. ‘pressure release’:ti,ab,kw 938
56. ‘aprv’:ti,ab,kw 380
57. ‘ippv’:ti,ab,kw 1 013
58. ‘nasal ventilation’:ti,ab,kw 408
59. ‘mask ventilation’:ti,ab,kw 2 409
60. ((‘non invasive’ OR ‘noninvasive’) NEAR/3 ‘ventilation’):ti,ab,kw 13 867
61. 31 OR 32 OR […] 60 85 368
Final 30 AND 61 175

 

Cochrane Library via Wiley 200323 
Non-invasiv ventilation for patients with COVID-19, SARS or MERS
Search terms Items found
Population:
1. "severe acute respiratory syndrome coronavirus 2":ti,ab 0
2. “2019 nCov”:ti,ab 2
3. 2019nCoV:ti,ab 0
4. “2019-nCov”:ti,ab 2
5. “CoVID-19”:ti,ab 2
6. CoVID19:ti,ab 0
7. SARS-CoV-2:ti,ab 0
8. CoVid:ti,ab 2
9. nCov:ti,ab 18
10. “novel coronavirus”:ti,ab 14
11. “new coronavirus”:ti,ab 4
12. "coronavirus 2019":ti,ab 9
13. “SARS coronavirus 2”:ti,ab 0
14. 1 OR 2 OR […] 13 22
15. [mh “Severe Acute Respiratory Syndrome”] 33
16. [mh “SARS Virus”] 9
17. “Severe acute respiratory syndrome":ti,ab 45
18. “SARS”:ti,ab 129
19. "SARS-CoV":ti,ab 0
20. 15 OR 16 OR […] 19 145
21. [mh “Middle East Respiratory Syndrome Coronavirus”] 1
22. [mh ^”Coronavirus Infections”] 21
23. MERS:ti,ab 33
24. "MERS-CoV":ti,ab 0
25. “Middle East respiratory syndrome”:ti,ab 12
26. “Middle East respiratory syndrome-related coronavirus”:ti,ab 0
27. "EMC/2012":ti,ab 0
28. 21 OR 22 OR […] 27 49
29. 14 OR 20 OR 28 193
Intervention:
30. [mh ”Positive‐Pressure Respiration”] 2627
31. (Positive NEAR/3 pressure):ti,ab 7200
32. (positive NEAR/3 airway):ti,ab 4116
33. CPAP:ti,ab 4344
34. [mh “Noninvasive Ventilation”] 208
35. (”Noninvasive ventilation” OR ”Non invasive ventilation”):ti,ab 2369
36. “Bi LevelPAP”:ti,ab 0
37. ”BiPAP”:ti,ab 312
38. ”Niv”:ti,ab 1014
39. “Positive end expiratory pressure”:ti,ab 1220
40. “Peep”:ti,ab 1609
41. (“NIPPV” OR ”NPPV”):ti,ab 483
42. ((Pressure NEAR/3 support) OR NIPSV):ti,ab 1230
43. (("Non invasive" OR "Noninvasive") NEAR/3 ("assisted ventilation" OR "Mechanical ventilation" OR "Artificial ventilation")):ti,ab 335
44. “NIAV”:ti,ab 0
45. ((pressure NEAR/3 release) OR “aprv”):ti,ab 221
46. "ippv":ti,ab 158
47. (Nasal NEAR/3 ventilation).ti,ab 3871
48. (Mask NEAR/3 ventilation):ti,ab 806
49. 30 OR 31 OR […] 48 16362
Final 29 AND 49 7

 

CINAHL via EBSCO 200323 
Non-invasiv ventilation for patients with COVID-19, SARS or MERS
The search result, usually found at the end of the documentation, forms the list of abstracts
Search terms Items found
Population:
1. TI "severe acute respiratory syndrome coronavirus 2" OR AB "severe acute respiratory syndrome coronavirus 2” 8
2. TI "2019 nCoV" OR AB "2019 nCoV” 2
3. TI 2019nCoV OR AB 2019nCoV 0
4. TI “2019-nCov” OR AB “2019-nCov” 58
5. TI CoVID-19 OR AB CoVID-19 103
6. TI CoVID19 OR AB CoVID19 1
7. TI SARS-CoV-2 OR AB SARS-CoV-2 21
8. TI “SARS CoV 2” OR AB “SARS CoV 2” 1
9. TI CoVid OR AB CoVid 1
10. TI nCov OR AB nCov 9
11. TI “novel coronavirus” OR AB “novel coronavirus” 188
12. TI “new coronavirus” OR AB “new coronavirus” 34
13. TI "coronavirus 2019” OR AB coronavirus 2019” 59
14. TI “SARS coronavirus 2” OR AB “SARS coronavirus 2” 0
15. 1 OR 2 OR […] 14 319
16. MH “Severe Acute Respiratory Syndrome” 1 989
17. MH “SARS Virus” 156
18. TI Severe acute respiratory syndrome” OR AB “Severe acute respiratory syndrome” 1 042
19. TI SARS OR AB SARS 2 286
20. TI SARS-CoV OR AB SARS-CoV 93
21. 15 OR 16 OR […] 20 3 304
22. MH “Middle East Respiratory Syndrome Coronavirus” 396
23. MH “Middle East Respiratory Syndrome” 245
24. TI MERS OR AB MERS 954
25. TI MERS-CoV OR AB MERS-CoV 398
26. TI “Middle East respiratory syndrome” OR AB “Middle East respiratory syndrome” 608
27. TI “Middle East respiratory syndrome-related coronavirus” OR AB “Middle East respiratory syndrome-related coronavirus” 2
28. TI “EMC/2012” OR AB “EMC/2012” 4
29. 22 OR 23 OR […] 28 1 188
30. 15 OR 21 OR 29 4 547
Intervention:
31. (MH ”Positive Pressure ventilation+) 11596
32. TI ”Positive pressure” OR AB”Positive pressure” 2567
33. TI ”positive airway” OR AB positive airway” 4499
34. TI CPAP OR AB CPAP 3016
35. (MH “Oxygen Delivery Devices”+) 3442
36. (MH "Ventilators, Mechanical") 2730
37. TI "Noninvasive ventilation" OR AB "Noninvasive ventilation" OR TI "Non invasive ventilation" OR AB "Non invasive ventilation" 2508
38. TI "Bi LevelPAP" OR AB "Bi LevelPAP" 0
39. TI BiPAP OR AB BiPAP 222
40. TI Niv OR AB Niv 1082
41. TI "Positive end-expiratory pressure" OR AB "Positive end-expiratory pressure" 1927
42. TI Peep OR AB Peep 1608
43. TI NIPPV OR AB NIPPV OR TI " NPPV" OR AB " NPPV" 405
44. TI "Pressure support" OR AB "Pressure support" OR TI NIPSV OR AB NIPSV 911
45. (TI "Non invasive" OR AB "Non invasive" OR TI Noninvasive OR AB Noninvasive) AND (TI "assisted ventilation" OR AB "assisted ventilation" OR TI "Mechanical ventilation" OR AB "Mechanical ventilation" OR TI "Artificial ventilation" OR AB "Artificial ventilation") 1165
46. TI NIAV OR AB NIAV 2
47. TI "pressure release" OR AB "pressure release" OR TI aprv OR AB aprv 269
48. TI ippv OR AB ippv 151
49. TI "Nasal ventilation" OR AB "Nasal ventilation" 49
50. TI "Mask ventilation" OR AB "Mask ventilation" 622
51. 31 OR 32 OR […] 50 23163
Final 30 AND 51 42
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