{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T06:48:01Z","timestamp":1775112481462,"version":"3.50.1"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>CENTRAL, MEDLINE\/PubMed, Cochrane Library, and Scopus were systematically searched up to August 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p = 0.23) (95% CI = 0.94\u20131.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08\u20130.43) with homogeneity (p = 0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43\u20130.76) with persistent heterogeneity (I2 = 98%, p&lt;0.001). Meta-regression showed that outcome from IMV improved with time (p&lt;0.001). Age had no statistically significant effect on mortality (p = 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger\u2019s test with p = 0.714 and Begg&amp;Mazumdar test with p = 0.334.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Interpretation<\/jats:title>\n<jats:p>The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252760","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T18:35:13Z","timestamp":1622831713000},"page":"e0252760","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":29,"title":["Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7597-6070","authenticated-orcid":true,"given":"Hany Hasan","family":"Elsayed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aly Sherif","family":"Hassaballa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taha Aly","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Gumaa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazem Youssef","family":"Sharkawy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Assem Adel","family":"Moharram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"pone.0252760.ref001","first-page":"145","article-title":"[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]","volume":"41","year":"2020","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"pone.0252760.ref002","first-page":"2633","volume-title":"Coronavirus disease (COVID-19) Situation Report\u2013 107","author":"WHO","year":"2020"},{"key":"pone.0252760.ref003","first-page":"1663","article-title":"COVID-19 vaccines: comparison of biological, pharmacological characteristics and adverse effects of Pfizer\/BioNTech and Moderna Vaccines","volume":"25","author":"SA Meo","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"pone.0252760.ref004","first-page":"145","article-title":"The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China","volume":"41","author":"V Surveillances","year":"2020","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"issue":"11","key":"pone.0252760.ref005","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1164\/rccm.202004-1076ED","article-title":"Basing respiratory management of COVID-19 on physiological principles","volume":"201","author":"MJ Tobin","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0252760.ref006","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1164\/rccm.202006-2405OC","article-title":"Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. 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Med"},{"key":"pone.0252760.ref027","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/0194599820929640","article-title":"Factors Associated With Intubation and Prolonged Intubation in Hospitalized Patients With COVID-19","volume":"163","author":"K Hur","year":"2020","journal-title":"Otolaryngol neck Surg Off J Am Acad Otolaryngol Neck Surg"},{"key":"pone.0252760.ref028","doi-asserted-by":"crossref","first-page":"m1966","DOI":"10.1136\/bmj.m1966","article-title":"Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study","volume":"369","author":"CM Petrilli","year":"2020","journal-title":"BMJ"},{"key":"pone.0252760.ref029","doi-asserted-by":"crossref","first-page":"m1985","DOI":"10.1136\/bmj.m1985","article-title":"Features of 20\u2009133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study","volume":"369","author":"AB Docherty","year":"2020","journal-title":"BMJ"},{"issue":"10","key":"pone.0252760.ref030","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1097\/CCM.0000000000002621","article-title":"Critically Ill Patients With the Middle East Respiratory Syndrome: A Multicenter Retrospective Cohort Study","volume":"45","author":"YM Arabi","year":"2017","journal-title":"Crit Care Med"},{"issue":"6","key":"pone.0252760.ref031","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1164\/rccm.201706-1172OC","article-title":"Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome","volume":"197","author":"YM Arabi","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0252760.ref032","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ijid.2019.01.041","article-title":"Macrolides in critically ill patients with Middle East Respiratory Syndrome","volume":"81","author":"YM Arabi","year":"2019","journal-title":"Int J Infect Dis"},{"issue":"2","key":"pone.0252760.ref033","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/20009666.2018.1450592","article-title":"Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample","volume":"8","author":"R Dhital","year":"2018","journal-title":"J Community Hosp Intern Med Perspect"},{"issue":"17","key":"pone.0252760.ref034","doi-asserted-by":"crossref","first-page":"e0487","DOI":"10.1097\/MD.0000000000010487","article-title":"Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD)","volume":"97","author":"SK Gadre","year":"2018","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0252760.ref035","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1006\/jsre.2000.5925","article-title":"Outcome and quality of life of patients with acute pancreatitis requiring 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