ABSTRACT
BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.
ABSTRACT
Introduction and Objectives There has been minimal evidence of early symptom outcomes of hospitalised covid-19 patients in the UK. The British Thoracic Society (BTS) has published guidance on recommended follow up for covid-19 patients with radiological pneumonia, but there is general concern about the respiratory and general health of all covid-19 patients. Less is known about early clinical symptoms, including psychological effects, and what interventions may be required to address these. Methods We collected data for all hospital admissions to a district general hospital, that were successfully discharged, which tested positive for COVID-19 by nasal swab PCR between 7th March and 20th July 2020. They were stratified into five protocols of severity. All patients were followed-up 4-6 weeks post discharge with a holistic telephone call questionnaire via our virtual ward. The patients were triaged and managed accordingly with phone advice/sending information packs, and discussion at the weekly virtual MDT for those with significant concerns. Results 312 patients were identified but 55(18%) patients were non-contactable by phone and 18(6%) died post discharge. Of the remaining 239 patients, 167(70%) were considered to have no ongoing issues. Of the 72 patients with issues identified, 43 patients (18%) were found to be more breathless than their baseline, including 6 patients without pneumonia. 42% of ICU discharges and 20% with severe pneumonia were more breathlessness than baseline. 32 patients (13.4%) reported adverse psychological effects, with sleep disturbance in 19 patients (7.9%) and low mood or increased anxiety in 18 patients (7.5%). 41(17.2%) patients' mobility hadn't returned to baseline levels. Only 4 patients (1.3%) had radiological evidence or treated as PE during the admission. Conclusions The majority of covid-19 admissions had no significant issues at 4 to 6 weeks follow-up. Breathlessness was not exclusive to those with radiological pneumonia but the likelihood was increased in ICU admissions and those with severe pneumonia. There was relatively high burden of new psychological symptoms and impaired mobility, which again was most common in ICU admissions. Virtual follow-up is an effective way of identifying those with symptoms who may benefit from early interventions, and enables faster access to specialist support.
ABSTRACT
P167 Figure 1ConclusionsThe majority of covid-19 admissions had no significant issues at 4 to 6 weeks follow-up. Breathlessness was not exclusive to those with radiological pneumonia but the likelihood was increased in ICU admissions and those with severe pneumonia. There was relatively high burden of new psychological symptoms and impaired mobility, which again was most common in ICU admissions. Virtual follow-up is an effective way of identifying those with symptoms who may benefit from early interventions, and enables faster access to specialist support.