COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Etiology Cournoyer A, Grand`Maison S, Lonergan AM, et al. Oxygen Therapy and Risk of Infection for Health Care Workers Caring for Patients With Viral Severe Acute Respiratory Infection: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020 Aug 10. pii: S0196-0644(20)30499-6. doi: 10.1016/j.annemergmed.2020.06.037.
Abstract

STUDY OBJECTIVE: To synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection. Health care workers face significant risk of infection when treating patients with a viral severe acute respiratory infection. To ensure health care worker safety and limit nosocomial transmission of such infection, it is crucial to synthesize the evidence regarding the infection risk associated with different modalities of oxygen therapy used in treating patients with severe acute respiratory infection.

METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to April 1, 2020, for studies describing the risk of infection associated with the modalities of oxygen therapy used for patients with severe acute respiratory infection. The study selection, data extraction, and quality assessment were performed by independent reviewers. The primary outcome measure was the infection of health care workers with a severe acute respiratory infection. Random-effect models were used to synthesize the extracted data.

RESULTS: Of 22,123 citations, 50 studies were eligible for qualitative synthesis and 16 for meta-analysis. Globally, the quality of the included studies provided a very low certainty of evidence. Being exposed or performing an intubation (odds ratio 6.48; 95% confidence interval 2.90 to 14.44), bag-valve-mask ventilation (odds ratio 2.70; 95% confidence interval 1.31 to 5.36), and noninvasive ventilation (odds ratio 3.96; 95% confidence interval 2.12 to 7.40) were associated with an increased risk of infection. All modalities of oxygen therapy generate air dispersion.

CONCLUSION: Most modalities of oxygen therapy are associated with an increased risk of infection and none have been demonstrated as safe. The lowest flow of oxygen should be used to maintain an adequate oxygen saturation for patients with severe acute respiratory infection, and manipulation of oxygen delivery equipment should be minimized.

Ratings
Discipline / Specialty Area Score
Intensivist/Critical Care
Infectious Disease
Occupational and Environmental Health
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Respirology/Pulmonology
Comments from MORE raters

Hospital Doctor/Hospitalists rater

The study is timely as it addresses the concern around oxygen delivery mode and risk for SARS. Though the findings are mostly known, it is worthwhile getting the evidence backing it.

Infectious Disease rater

This is extremely interesting in addressing a subject that has not been adequately studied and presented in its entirety.

Intensivist/Critical Care rater

This is an interesting and timely systematic review. Some methodological limitations exist.

Internal Medicine rater

It is not possible to draw conclusions regarding every-day clinical practice from this meta-analysis due to lack of good-quality evidence.