Ward-based continuous positive airway pressure (CPAP) in SARS-CoV-2

Introduction Continuous positive airway pressure (CPAP) therapy had been previously shown to reduce the need for invasive mechanical ventilation (IMV) in cardiogenic pulmonary oedema, but evidence of its efficacy in viral-induced respiratory failure is limited and is a subject of debate.1,2 An early intubation strategy without trial of non-invasive ventilation (NIV) had been previously suggested, while others have argued for timely, but not premature, intubation.3 We retrospectively evaluated the efficacy of CPAP in patients with COVID-19 at a single centre. Exclusion criteria were <16 years old, pregnancy, acute-on-chronic hypercapnic respiratory failure and acute respiratory failure from an alternative diagnosis to SARS-CoV-2. Early intubation strategy was previously fiercely advocated due to concerns of exceedingly high NIV failure rate in MERS, infection transmission risks and poorer outcomes with delayed intubation.4-6 In a non-SARS-CoV-2 population, the LUNGSAFE study showed higher ICU mortality with NIV use in patients with PaO2/FiO2 <150 mmHg compared with early intubation.6 Data in SARS-CoV-2 are not available.