Retrospective analysis of CPAP use against outcome in those admitted to intensive care with COVID-19

Articles in Press

Document Type : Original Article

Authors

1 Intensive care unit, James Cook University Hospital, South Tees, Middlesbrough

2 Intensive care unit, James cook university hospital, South tees, Middlesbrough

3 Intensive care unit, James Cook University Hospital, South tees, Middlesbrough

Abstract

Abstract
BACKGROUND:
Initial guidance on managing COVID-19 respiratory sequelae suggested early intubation be used to treat deteriorating patients, however at James Cook University Hospital (JCUH) a trial of CPAP (Continuous positive airway pressure) was used when patients required more than 15 litres of oxygen.

METHODS:
We conducted a retrospective cohort study to see if this use of CPAP had protective properties against COVID-19 in Intensive Care Unit (ICU) patients. Patients included were admitted to JCUH ICU on or after 01/02/2020, and discharged before or on 31/05/2020, with their primary reason for admission to ICU being ‘Pandemic Influenza’. Patients were excluded if they were intubated before admission to JCUH, invasively ventilated before they had CPAP, or received CPAP via a tracheostomy.

RESULTS:
86 patients met the inclusion criteria (n=86). 6 did not receive CPAP or invasive ventilation, 67 had CPAP, of whom 23 were subsequently invasively ventilated, and 13 patients were invasively ventilated without prior CPAP. Patients escalated from CPAP to invasive ventilation had the highest mortality rate (95.65%), and the difference in outcome between patients who had CPAP and those who did not, was not statistically significant (p=0.885). There was a weak correlation (+0.25, p=0.042) between an increased number of days of CPAP and patients being discharged alive.


CONCLUSION:
Having CPAP was not associated with an improvement in patient mortality, however, patients who received CPAP for a greater number of days were more likely to survive. Disease severity (PaO2/FiO2 ratio) was the most strongly correlated factor with patient outcome.

Keywords

Ain Shams Medical Journal

Articles in Press, Accepted Manuscript
Available Online from 01 October 2024

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