Abstract
Background:The optimum management of respiratory failure in patients with coronavirus (COVID-19) infections 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.Methods:We 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 groups of patients was also analyzed.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 patients). Twenty-four patients received CPAP as the ceiling of care, with a mortality rate of 92.5%. The remaining 84 patients who were on oxygen as a ceiling of treatment had 91.7% mortality. Both population groups had a similar number of comorbidities but were less favorable in terms of age in the control group with standard O2 therapy than those who had CPAP support. Overall mortality outcomes from using CPAP therapy did not bring significant mortality benefit (p-value-0.89).Conclusion:CPAP did not appear to improve the survival of patients with severe respiratory failure due to COVID-19 related pneumonia and were not suitable for invasive ventilation. Further studies are warranted to adequately inform appropriate management strategies for this group of patients.
Highlights
The optimum management of respiratory failure in patients with coronavirus (COVID-19) infections has been a challenge for physicians across the globe
In our study, we investigated the mortality outcomes of CPAP use in patients with respiratory failure secondary to severe COVID-19 infection who were deemed not fit for invasive ventilation and compared it to patients who were managed on high concentration oxygen alone
Sixteen (16) of them were treated with CPAP, and the rest were treated with oxygen therapy alone
Summary
The optimum management of respiratory failure in patients with coronavirus (COVID-19) infections 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. Severe COVID-19 infection causing respiratory failure requiring high-level care is, an ongoing global problem, posing a considerable strain on hospital resources. The optimum management of such cases with different modalities of respiratory support and their effectiveness in certain groups of COVID-19 patients has not been extensively reported [4]. In England, expert groups and guideline committees have rolled out clear, concise guidance on patient selection regarding escalation of care and eligibility
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