Use of protracted CPAP as a supportive treatment for COVID-19 pneumonitis and associated outcomes: a national cohort study

Puxty, K. A. , Blayney, M., Kaye, C., McPeake, J. , Stewart, N., Paton, M., Hall, R., Donaldson, L. and Lone, N. (2023) Use of protracted CPAP as a supportive treatment for COVID-19 pneumonitis and associated outcomes: a national cohort study. British Journal of Anaesthesia, (doi: 10.1016/j.bja.2023.05.012) (PMCID:PMC10209449) (In Press)

Abstract

Background: Continuous positive airway pressure (CPAP) has been increasingly deployed to manage patients with COVID-19 and hypoxemic respiratory failure, often for protracted periods. However, concerns about protracted CPAP have been raised. This study aims to examine the use of CPAP for patients with COVID-19 and the outcomes after protracted use. Methods: This is a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from 01/03/20 to 25/12/21 that received CPAP. Protracted CPAP was defined as ≥ 5 continuous days of CPAP. Outcomes included CPAP failure rate (institution of invasive mechanical ventilation (IMV) or death), mortality, and outcomes following institution of IMV. Multivariable logistic regression was performed to assess the impact of protracted CPAP on mortality after IMV. Results: 1961 patients with COVID-19 received CPAP for COVID pneumonitis with 733 patients (37.4%) receiving protracted CPAP. CPAP failure occurred in 891 (45.4%): 544 patients (27.7%) received IMV and 347 patients (17.7%) died in critical care without IMV. Hospital mortality rate was 41.3% for the population. For patients that subsequently commenced IMV, hospital mortality was 58.7% for the standard duration CPAP group and 73.9% for the protracted duration CPAP group (p=0.003), however, there was no statistical difference in hospital mortality after adjustment for confounders (OR 1.4, (95% CI 0.84, 2.33, p=0.195). Conclusions: Protracted CPAP was used frequently for managing patients with COVID-19. Whilst it was not associated with worse outcomes for those patients who subsequently required IMV, this may be due to residual confounding and differences in processes of care.

• Item Type: Articles
• Keywords: COVID-19, continuous positive airway pressure, CPAP, non-invasive ventilation, pneumonitis, ARDS.
• Status: In Press
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McPeake, Dr Jo and Puxty, Dr Kathryn
• Authors: Puxty, K. A., Blayney, M., Kaye, C., McPeake, J., Stewart, N., Paton, M., Hall, R., Donaldson, L., and Lone, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: British Journal of Anaesthesia
• Publisher: Elsevier
• ISSN: 0007-0912
• ISSN (Online): 1471-6771
• Published Online: 25 May 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in British Journal of Anaesthesia 2023
• Publisher Policy: Reproduced under a Creative Commons License