Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation.
Patrick Bradley, James P. Wilson, Rebecca Taylor, Jennifer Nixon, James Redfern, Paul Whittemore, Mariam Gaddah, Kanishka Kavuri, Andreana P. Haley, Peppa Denny, Charlotte Withers, RC Robey, Chloe A Logue, N Dahanayake, David Min, Jonathan Coles, Mr. Soham Deshmukh, Sebastian Ritchie, Muhammed Anwar Malik, Hala Mahmoud Sayed Abdelaal, K. Sivabalah, MD Hartshorne, D Gopikrishna, Abdul Ashish, Emily Nuttall, Andrew Bentley, Thomas Bongers, Timothy Gatheral, TW Felton, Nazia Chaudhuri, Laurence Pearmain
Abstract
BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: 4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.