CPAP improves oxygen saturation and breathing rate in COVID-19 patients

Abstract

<b>Introduction:</b> COVID-19 pneumonia often leads to hypoxic respiratory failure. Oxygen administration via nasal cannula and high-flow nasal oxygen (HFNO) are used for treatment. In addition, several reports indicate beneficial effects of CPAP. We established CPAP therapy with a specialised team (pulmonologists, respiratory therapists) on the COVID-19 ward. In this study we present the effects on oxygen saturation (spO2) and respiratory rate under CPAP. <b>Methods:</b> Patients with respiratory insufficiency due to COVID-19 and pulmonary infiltrates on CT scan were treated with CPAP. Oxygen delivery via nasal cannula or HFNO was titrated to achieve a target spO2 between 92% and 95% prior to therapy. SpO2, respiratory rate and dyspnoea on the Borg scale (0-10) were measured 5 minutes before and after CPAP under identical settings. Results were analysed using the rank sum test for paired samples. <b>Results:</b> 87 patients were included (61 men, 26 women, mean age 63.5 ±14.6 y). 4C_MS was 9.6 ±3.9. The median duration of CPAP application was 60 minutes. Except in two patients, this was the first treatment with CPAP. SpO2 increased significantly by 1.3% (92.4 ±2.3% versus 93.7 ±1.7%, p&lt; 0.001), respiratory rate decreased significantly by 2.1/min (24.2 ±6.0 versus 22.0 ±5.1, p&lt; 0.001). Patients experienced less breathlessness after CPAP therapy (Borg median 2.7 versus 1.9, p&lt; 0.001). <b>Conclusion:</b> In the short term, CPAP therapy improves oxygen saturation and reduces respiratory rate and dyspnoea significantly in COVID-19 patients. For respiratory insufficiency in COVID-19 it can be applied safely on a general ward by a specialised respiratory team. Long term outcome, especially prevention of intubation, must be further evaluated.