Utility of Continuous Positive Airway Pressure (CPAP) in avoiding mechanical ventilation in COVID-19 patients

ABSTRACT

There has been much debate on how best to manage COVID pneumonitis. We established a Respiratory High Care Unit (RHCU) to provide CPAP for hypoxic patients as an intermediate between standard oxygen therapy (SOT) and mechanical ventilation (MV). In some centres, CPAP was not offered outside trial settings, meaning deteriorating patients went straight from SOT to MV.The RECOVERY-RS trial has found that CPAP reduces the need for MV in severe COVID. This study reported for every 12 people treated with CPAP, in comparison to SOT, 1 patient avoided MV.1Between 1/6/20 and 30/3/21, we admitted 156 patients to the RHCU. All patients met local Trust criteria for CPAP. Out of these, 69 patients (48%) were considered to be suitable for full escalation (intubation and mechanical ventilation on ITU). 1 patient died of non-COVID causes and was excluded. Of the remaining 68 patients, 72% improved with CPAP, with all patients surviving until discharge. 28% were transferred to intensive care for MV.Patients that avoided intubation had a mean age of 53.8 years, an average clinical frailty score (CFS) of 1.3 and a pO2 on admission to RHCU of 9.1kPa versus an age of 63.5 years, CFS of 1.5 and pO2 of 8.0kPa in those intubated.This analysis showed that CPAP was an effective modality of treatment, with 72% of patients avoiding going on to MV, which was the standard care provided in some other centres. For every 1.4 patients given CPAP, 1 MV was avoided. This data strongly supports emerging evidence on the benefit of CPAP in avoiding MV in COVID patients.Perkins G, Ji C, Connolly B, Couper K, Lall R, Baillie J et al. An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19. 2021.