ABSTRACT
BackgroundGuidance in COVID-19 respiratory failure has favoured early intubation, with concerns over the use of CPAP. We adopted early CPAP and self-proning, and evaluated the safety and efficacy of this approach. MethodsThis retrospective observational study included all patients with a positive COVID-19 PCR, and others with high clinical suspicion. Our protocol advised early CPAP and self-proning for severe cases, aiming to prevent rather than respond to deterioration. CPAP was provided outside critical care by ward staff supported by physiotherapists and an intensive critical care outreach program. Data were analysed descriptively and compared against a large UK cohort (ISARIC). Results559 patients admitted before 1/May/20 were included. 376 were discharged alive, and 183 died. 165 patients (29.5%) received CPAP, 40 (7.2%) were admitted to critical care and 28 (5.0%) were ventilated. Hospital mortality was 32.7%, and 50% for critical care. Following CPAP, 62% of patients with S:F or P:F ratios indicating moderate or severe ARDS, who were candidates for escalation, avoided intubation. Figures for critical care admission, intubation and hospital mortality are lower than ISARIC, whilst critical care mortality is similar. Following ISARIC proportions we would have admitted 92 patients to critical care and intubated 55. Using the described protocol, we intubated 28 patients from 40 admissions, and remained within our expanded critical care capacity. ConclusionBradfords protocol produced good results despite our population having high levels of co-morbidity and ethnicities associated with poor outcomes. In particular we avoided overloading critical care capacity. We advocate this approach as both effective and safe. Social media summaryThe use of early CPAP and proning in COVID-19 was associated with lower critical care admissions, intubation, and mortality at Bradford compared to a large UK cohort (ISARIC WHO CCP-UK).
ABSTRACT
The COVID-19 pandemic has placed a dramatic increase in demand on healthcare providers to provide respiratory support for patients with moderate to severe symptoms. In conjunction, the pandemic has challenged existing supply-chains to meet demands for medical equipment and resources. In response to these challenges, we report our work to repurpose two existing non-invasive ventilation (NIV) systems to provide solutions for the delivery of oxygen-enriched CPAP ventilation which are inherently resource and oxygen-efficient. We consider adaptation of CPAP systems typically used for sleep apnoea, together with a new Venturi-valve design which can be readily produced through 3D printing. Our aim in both cases was to support Positive end-expiratory pressure (PEEP) of [≥]10cmH2O while achieving [≥]40% FiO2. This supports a crucial part in the patient pathway for COVID-19 treatment, helping to provide early respiratory support prior to invasive ventilation options in the ICU.
