P57 Early use of continuous positive airway pressure (CPAP) in patients with respiratory failure due to Covid 19 Pneumonia

Abstract

<h3>Introduction and Objectives</h3> Up to 5% of patients with COVID 19 become seriously unwell due to respiratory failure of which a proportion require referral to the Intensive Care Unit (ICU). We designed a protocol to use CPAP early on the respiratory ward in confirmed Covid patients to reduce the need for ICU. Clinical trials are ongoing examining the effectiveness of CPAP versus other forms of oxygen delivery in reducing mortality.¹ <h3>Methods</h3> Covid patients in respiratory failure for escalation to ICU were considered for a trial of CPAP when their oxygen requirements exceeded 4L/minute. CPAP was started at a positive end expiratory pressure (PEEP) of 5 cm H2O and up titrated to maintain oxygen saturations greater than 94%. Demographic information, PEEP pressures, duration on CPAP, time to intubation if CPAP failed, ICU admission, hospital discharge and 60 day mortality was collected on CPAP responders and CPAP non responders over a six-week period. <h3>Results</h3> 43/353 patients (12%) admitted with Covid pneumonia to our hospital in respiratory failure were deemed suitable for a CPAP trial and were for escalation to ICU if CPAP failed. (Table 1). 23/43 (54%) responded favourably to CPAP and avoided ICU. Males were more likely to fail CPAP (48% vs 75%, p=0.07) within the first day (5 vs 1 day, p≤0.001). Hospital length of stay in CPAP responders was considerably shorter than CPAP non responders. <h3>Conclusions</h3> Over half of patients trialled on CPAP tolerated it well and avoided ICU admission with a shorter hospital stay. These were younger patients with relatively few comorbidities. Those who failed CPAP were mostly male and did so within the first 24 hours. The non-responders to CPAP all survived to hospital discharge. Early CPAP use in this group has had no adverse outcomes to date. More work is needed to look at the use of early CPAP in older patients with more medical co-morbidities in respiratory failure due to Covid pneumonia. <h3>Reference</h3> RECOVERY-RS Respiratory support : respiratory strategies in COVID-19; CPAP, High-flow, and standard care. Available: http://www.isrctn.com/ISRCTN16912075