RETROSPECTIVE ANALYSIS OF CPAP USE IN THOSE ADMITTED TO ICU WITH COVID-19 | ||||
| Ain Shams Medical Journal | ||||
| Article 19, Volume 73, Issue 3, September 2022, Page 681-693 PDF (734.37 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asmj.2022.270249 | ||||
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| Authors | ||||
| Krishna Chaitanya Ravulapalli; Tom Collis; Daniel Bell; Ashton Dsouza; Stephen Bonner | ||||
| The James Cook University Hospital, Middlesbrough, (England) | ||||
| Abstract | ||||
| Background: Initial guidance on managing COVID-19 respiratory sequalae suggested early intubation be used to treat deteriorating patients, however at James Cook University Hospital (JCUH) (centre name) a trial of CPAP (Continuous positive airway pressure) was used when patients required more than 15 litres of oxygen. Patients And 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. Key Messages: Our centres' analysis suggests that patient selection and timing of intubation in COVID-19 patients is critical. Patients who received only CPAP had the lowest mortality, however, those who were subsequently intubated had a higher mortality than those who were intubated earlier in their disease progression (without receiving CPAP first). A higher number of days of CPAP received was significantly associated with a positive outcome whereas hours per day of CPAP was not. | ||||
| Keywords | ||||
| Continuous Positive Airway Pressure; COVID-19; Critical Care; Intubation; Hypoxia | ||||
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