Predictors of continuous positive airway pressure (CPAP) response in severe hypoxaemic respiratory failure due to COVID-19 pneumonitis

Published Date: 14th September 2021

Publication Authors: Thompson J

Abstract
CPAP is advocated as a bridge to invasive mechanical ventilation (IMV) in severe COVID-19 pneumonitis. Its effectiveness in preventing intubation is unknown. We aimed to evaluate the outcomes COVID-19 patients suitable for IMV receiving CPAP following failure of standard oxygen therapy and predictors of CPAP response. We performed a retrospective observational study at The Royal Oldham Hospital, UK, including 95 consecutive patients between March 2020-February 2021. Patients desaturating on FiO2 >0.6 were commenced on CPAP 10cmH20 and FiO2 0.6 titrated to response. 34 patients (36%) avoided intubation using CPAP. CPAP non-responders were significantly older (64.2 vs 53.9, p<0.001). CPAP response in patients <70 was 46% vs 13% in >70. We found no significant difference in CPAP response between other measured variables. CPAP responders had reduced length of stay (LOS) (11 vs 29.8 days, p<0.001). In patients requiring enhanced respiratory support, CPAP avoided IMV in 36%. The only variable predictive of CPAP response was age. Further work is required to help establish the role of CPAP in COVID-19 including timing of interventions and predictors of CPAP response.

Shaw, J; Thompson, J et al. (2022). Predictors of continuous positive airway pressure (CPAP) response in severe hypoxaemic respiratory failure due to COVID-19 pneumonitis. European Respiratory Journal. 58 (Suppl 65), PA1088

 

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