RT Journal Article
SR Electronic
T1 CPAP delivered outside critical care during the second wave of COVID-19: outcomes from a UK respiratory surge unit
JF BMJ Open Respiratory Research
JO BMJ Open Resp Res
FD British Thoracic Society
SP e000907
DO 10.1136/bmjresp-2021-000907
VO 8
IS 1
A1 Rebecca Nightingale
A1 Joseph Lewis
A1 Katelyn Rhiannon Monsell
A1 Lewis Jones
A1 Christopher Smith
A1 Shantanu Kundu
A1 Helena Bond
A1 Hassan Burhan
A1 Tom Fletcher
A1 Thomas Blanchard
A1 Michael Beadsworth
A1 Peter Hampshire
A1 Manish Gautam
A1 Stacy Todd
A1 Gareth Jones
A1 Stephen Aston
YR 2021
UL http://bmjopenrespres.bmj.com/content/8/1/e000907.abstract
AB Background NHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling of care. However, data assessing this strategy are sparse, especially for the use of CPAP as a ceiling of care, and particularly when delivered outside of a traditional critical care environment. We describe a cohort of patients from Liverpool, UK, who received CPAP on a dedicated respiratory surge unit at the start of the second wave of the COVID-19 pandemic in UK.Methods Retrospective cohort analysis of consecutive patients receiving CPAP for the treatment of respiratory failure secondary to COVID-19 on the respiratory surge unit at the Royal Liverpool Hospital, Liverpool, UK from 21 September until 30 November 2020.Results 88 patients were included in the analysis. 56/88 (64%) were deemed suitable for escalation to invasive mechanical ventilation (IMV) and received CPAP as a trial; 32/88 (36%) received CPAP as a ceiling of care. Median age was 63 years (IQR: 56–74) and 58/88 (66%) were men. Median SpO2/FiO2 immediately prior to CPAP initiation was 95 (92–152). Among patients for escalation to IMV, the median time on CPAP was 6 days (IQR 4–7) and survival at day 30 was 84% (47/56) with 14/56 (25%) escalated to IMV. Of those patients for whom CPAP was ceiling of care, the median duration of CPAP was 9 days (IQR 7–11) and 18/32 (56%) survived to day 30. Pulmonary barotrauma occurred in 9% of the cohort. There were no associations found on multivariant analysis that were associated with all-cause 30-day mortality.Conclusions With adequate planning and resource redistribution, CPAP may be delivered effectively outside of a traditional critical care setting for the treatment of respiratory failure due to COVID-19. Clinicians delivering CPAP to patients with COVID-19 pneumonitis should be alert to the dangers of pulmonary barotrauma. Among patients who are for escalation of care, the use of CPAP may avoid the need for IMV in some patients. Our data support the NHS England recommendation to consider CPAP as a ceiling of care.Data are available upon reasonable request. Data is available upon reasonable request to the corresponding author. rebecca.nightingale@lstmed.ac.uk.