Continuous positive airway pressure (CPAP) as a ceiling of care treatment for hypoxemic respiratory failure due to COVID-19 (2021)

Type of publication:
Journal article

Patrick Bradley , *Jennifer Nixon , James Wilson , James Redfern , Tarek Saba , Emily Nuttall, Thomas Bongers

Journal of the Intensive Care Society 2021, Vol. 0(0), 1–3 [epub ahead of print]

Among patients admitted to hospital with COVID-19 in the UK, 10% develop severe hypoxemic respiratory failure managed with invasive mechanical ventilation (IMV). Much interest has focused on non-invasive strategies to avert progression to IMV. UK guidelines recommend the use of continuous positive airway pressure (CPAP), including in patients for whom IMV is not appropriate. However, other nations have recommended against the use of CPAP, and within the UK, CPAP use has varied widely (personal communication). The greatest burden of COVID-19 disease is carried by older patients with comorbidities, many of whom are deemed unsuitable for IMV and critical care. However, it is unclear whether they might benefit from CPAP. The RECOVERY-RS trial is investigating the efficacy of CPAP and high-flow nasal oxygen (HFNO) in severely hypoxic patients with COVID-19, but will not complete until late 2021, and excludes patients unsuitable for IMV. Current evidence is limited to cohort studies of heterogeneous patient groups, with no published data focussing on patients for whom CPAP is the ceiling-of-care. Physicians caring for such patients, and those involved in planning the delivery of CPAP services, must balance any potential benefits of CPAP against its burden on patients, families, staff, and services. Therefore data in this patient population are urgently needed.

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