ABSTRACT
Background: Patients admitted with COVID-19 pneumonia often have severe hypoxemic respiratory failure which requires additional support with CPAP/HFNO. It is not known which clinical variable best predicts the need for CPAP/HFNO. Aim(s): We reviewed consecutive patients admitted with COVID-19 to an acute respiratory care unit (ARCU) to assess, if any clinical or demographic data could help predict the need for CPAP/HFNO in a high risk group of patients, and also assessed their outcome. Method(s): Data collected from patients admitted to our ARCU with COVID-19 pneumonia between 28th November 2020 and 16th February 2021 was retrospectively reviewed. Clinical and demographic data was collected. The 4C mortality score for COVID-19 and chest x-ray scoring was performed. Result(s): 271 people were included in the study, CPAP/HFNO was initiated in 187 (73%). A CRP >100 (OR: 3.12, CI:1.8-5.4), or a respiratory rate >=30 (OR: 9.54, CI:3.9-26) at admission were associated with requiring CPAP/HFNO. A severe degree of zonal involvement on chest x-ray (OR: 3.65, CI:1.8-7.6) predicted the need for CPAP/HFNO. The 4C mortality score showed a step wise increase in the odds of needing CPAP/HFNO. 144 patients were commenced on CPAP/HFNO who were for escalation to invasive ventilation, 45% required escalation to invasive ventilation. 43 patients underwent CPAP/HFNO as a ceiling of care, 35 of which died resulting in an 81% mortality. Discussion(s): It is possible to predict which patients may require CPAP/HFNO using easily available clinic data. CPAP/HFNO as a ceiling of care in severe COVID-19 can be associated with a very high risk of mortality and should be carefully considered.