P58 Reviewing the role of continuous positive airway pressure (CPAP) in patients with severe COVID-19: a multi-site observational study

Introduction and ObjectivesThe COVID-19 pandemic saw unprecedented pressure placed upon healthcare services and demand for additional Critical Care capacity National guidance recommended CPAP as a treatment option for patients with severe hypoxaemic respiratory failure We present our experience and clinical outcomes of patients with severe COVID-19 treated with CPAP MethodsClinical data was prospectively collated for all patients treated with CPAP for COVID-19 at two hospital sites Both sites used the same treatment algorithm, involving a stepwise progression of oxygen therapy, CPAP and escalation to mechanical ventilation if appropriate CPAP was delivered within ED resus, respiratory ward CPAP area, respiratory HDU or Intensive Care Unit (ICU) Inclusion criteria included confirmed SARS-CoV2 infection by nasopharyngeal swab PCR;age³18;FiO2³0 4 with increased work of breathing or FiO2³0 6 to maintain target oxygen saturation;Level 2 or 3 treatment escalation plan (TEP);treatment with CPAP Results115 patients were identified, 22% female Median age was 67(36–92) years, and Clinical Frailty Score 2(1–9) At initiation of CPAP, S:F ratio was 118(87–245) and supplemental oxygen was FiO2=0 8) Diabetes was present in 64%, hypertension in 61%, cardiac disease in 22% and respiratory disease in 17% 84 patients had a Level 3 TEP 30-day mortality in this group was 29% 50% required escalation to invasive ventilation and 30-day mortality was 50%, reflective of early national data In those who avoided intubation, mortality was 11% 31 patients had a Level 2 TEP, where CPAP was the ceiling of treatment 30-day mortality was 74% Admission to ICU was avoided in 67 of 115 patients Mortality in this group was 40% Median CPAP use was 3(1–11) days Survivor length of stay was 55(18–94) days in ICU mechanically ventilated patients vs 11(5–53) days in ward treated patients ConclusionIn patients with COVID-19 and severe hypoxaemic respiratory failure, mortality was high Our results showed that intubation can be avoided in 50% of patients treated with CPAP 30-day mortality in patients subsequently mechanically ventilated was 50% but was only 11% in those who avoided intubation Further work is needed to assess the impact of CPAP on clinical outcomes in patients with COVID-19 pneumonia