Role of CPAP in management of patients with Covid-19 infections who are not suitable for mechanical ventilation: a real-world observational study

BackgroundThe optimum management of respiratory failure in COVID-19 patients has been a challenge for physicians across the globe. Many scientific societies have suggested the use of CPAP (continuous positive airway pressure) in severe cases, in an effort to reduce invasive ventilation. We investigated mortality outcomes in patients who needed CPAP but were not suitable for invasive ventilation.MethodsWe retrospectively evaluated the mortality outcomes of all consecutive COVID-19 cases with severe type 1 respiratory failure requiring FiO2 >0.6 who were admitted to our hospital between 12th March and 04th May’20. British Thoracic Society guidelines were followed for identifying patients needing CPAP. Their outcomes were recorded and compared with a similar group of patients who had oxygen as a ceiling of care. Prospectively collected data between 5th May and 7th June’20 in similar but smaller group of patients was also analysed.Results:A total of 104 COVID-19 patients with documented Do Not Attempt Resuscitation (DNAR) decision required high fraction of inspired oxygen (FiO2) >0.6 to maintain peripheral oxygen saturation (SpO2)> 92% (SpO2> 88% in COPD). 24 received CPAP as the ceiling of care with a mortality rate of 92.5%. The remaining 80 patients who were on oxygen as a ceiling of treatment had 91.7% mortality.Conclusion CPAP did not appear to improve survival of patients with severe respiratory failure due to COVID-19 who were not suitable for invasive ventilation. Further studies are warranted to adequately inform appropriate management strategies for this group of patients.KeywordsCPAP; non-invasive ventilation; COVID-19; critically ill; respiratory failure