The role of CPAP as a potential bridge to invasive ventilation and as a ceiling-of-care for patients hospitalized with Covid-19-An observational study

Continuous positive airway pressure (CPAP) ventilation may be used as a potential bridge to invasive mechanical ventilation (IMV), or as a ceiling-of-care for persistent hypoxaemia despite standard oxygen therapy, according to UK guidelines. We examined the association of mode of respiratory support...

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Bibliographic Details
Published in:PloS one 2020-12, Vol.15 (12), p.e0244857-e0244857
Main Authors: Walker, Jonathan, Dolly, Shaman, Ng, Liji, Prior-Ong, Melissa, Sabapathy, Kalpana
Format: Article
Language:English
Subjects:
Adult
Biology and life sciences
Continuous positive airway pressure
Continuous Positive Airway Pressure - economics
Coronaviruses
COVID-19
COVID-19 - economics
COVID-19 - epidemiology
COVID-19 - therapy
Dementia
Diabetes
Evaluation
Female
Hospitalization - economics
Hospitals
Humans
Intubation
Japan - epidemiology
Male
Mechanical ventilation
Medicine and Health Sciences
Middle Aged
Mortality
Observational studies
Oxygen
Oxygen - administration & dosage
Oxygen therapy
Pandemics
Patient outcomes
Physical Sciences
Practice guidelines (Medicine)
Protective equipment
Retrospective Studies
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Therapy
Ventilation
Ventilators
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Summary:Continuous positive airway pressure (CPAP) ventilation may be used as a potential bridge to invasive mechanical ventilation (IMV), or as a ceiling-of-care for persistent hypoxaemia despite standard oxygen therapy, according to UK guidelines. We examined the association of mode of respiratory support and ceiling-of-care on mortality. We conducted a retrospective cohort analysis of routinely collected de-identified data of adults with nasal/throat SARs-CoV-2 swab-positive results, at the Calderdale and Huddersfield NHS Foundation Trust between 10th March-19th April 2020 (outcomes determined on 22nd May). Of 347 patients with SARs-CoV-2 swab-positive results, 294 (84.7%) patients admitted for Covid-19 were included in the study. Sixty-nine patients were trialled on CPAP, mostly delivered by face mask, either as an early ceiling of care instituted within 24 hours of admission (N = 19), or as a potential bridge to IMV (N = 44). Patients receiving a ceiling of care more than 24 hours after admission (N = 6) were excluded from the analysis. Two hundred and fifteen patients (73.1%) maximally received air/standard oxygen therapy, and 45 (15.3%) patients maximally received CPAP. Thirty-four patients (11.6%) required IMV, of which 24 had received prior CPAP. There were 138 patients with an early ceiling-of-care plan (pre-admission/within 24h). Overall, 103(35.0%) patients died and 191(65.0%) were alive at study end. Among all patients trialled on CPAP either as a potential bridge to IMV (N = 44) or as a ceiling-of-care (N = 19) mortality was 25% and 84%, respectively. Overall, there was strong evidence for higher mortality among patients who required CPAP or IMV, compared to those who required only air/oxygen (aOR 5.24 95%CI: 1.38, 19.81 and aOR 46.47 95%CI: 7.52, 287.08, respectively; p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0244857