{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:27:20Z","timestamp":1778599640477,"version":"3.51.4"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>BACKGROUND<\/jats:title>\n            <jats:p>Noninvasive respiratory support (NIRS) has been revealed feasible solutions to cope with the massive request for ventilatory support in patients subjected to \u2018do-not-intubate\u2019 order (DNI).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>OBJECTIVES<\/jats:title>\n            <jats:p>The aims of the present systematic review and meta-analysis was to estimate pooled incidence of DNI orders and the associated in-hospital mortality in patients undergoing NIRS for hypoxaemic acute respiratory failure (ARF) related to coronavirus disease 2019 (COVID-19).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DESIGN<\/jats:title>\n            <jats:p>Systematic review of observational studies and randomized-controlled trials with meta-analyses<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DATA SOURCES<\/jats:title>\n            <jats:p>PUBMED, EMBASE, and Cochrane Controlled Clinical trials register were searched for observational studies and randomised-controlled trials from inception to the end of April 2022.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>ELIGIBILITY CRITERIA<\/jats:title>\n            <jats:p>Inclusion criteria were: observational studies enrolling \u226550 hospitalised patients with hypoxaemic COVID-19-related ARF requiring NIRS and DNI order application. Two authors independently extracted data from enrolled investigations. Data are presented as proportions with 95% confidence interval.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>Thirty-one observational studies were included for a total of 6645 COVID-19 patients undergoing NIRS, of whom 1590 received DNI orders. Among patients assisted by NIRS, a DNI order was expressed in a summary estimate of 25.4% [20.0\u201331.1] of the cases with a high between-study heterogeneity. The summary estimated of in-hospital mortality was 83.6% [75.3\u201390.7] for DNI patients and 20.0% [14.2\u201326.5] for full treatment patients, both with a high between-study heterogeneity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS<\/jats:title>\n            <jats:p>In COVID-19 patients assisted through NIRS for hypoxaemic ARF, a DNI order was frequently issued and associated with a high in-hospital mortality<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>TRIAL REGISTRATION<\/jats:title>\n            <jats:p>Prospero registration number: CRD42021271313.<\/jats:p>\n          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