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Use of noninvasive ventilation (NIV) to support patients with respiratory failure caused by COVID-19 has been controversial. In the setting of ventilator shortages, NIV would lower demand for a scarce resource if intubation can be avoided. The concern, however, has been that healthcare workers might be at excess risk due to aerosolization of virus with NIV.
In a systematic review commissioned by the World Health Organization, investigators analyzed data related to NIV (including high-flow nasal cannula) and invasive ventilation for COVID-19, as well as other coronavirus infections (SARS and MERS). They included studies of risk for transmission and investigations of various respiratory support strategies for hypoxemic respiratory failure in g…