The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic

Claudia Brusasco; Francesco Corradi; Federico Dazzi; Alessandro Isirdi; Chiara Romei; Andrea Parisini; Silvia Boni; Gregorio Santori; Vito Brusasco; Galliera CPAP-COVID-19 study group; Galliera CPAP-COVID-19 study group

doi:10.1183/23120541.00365-2022

The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic

ERJ Open Res. 2023 Mar 6;9(2):00365-2022. doi: 10.1183/23120541.00365-2022. eCollection 2023 Mar.

Affiliations

¹ Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy.
² Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
³ Department Radiology, 2nd Radiology Unit, Pisa University-Hospital, Pisa, Italy.
⁴ E.O. Ospedali Galliera, Genoa, Italy.
⁵ Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
⁶ Department of Experimental Medicine, University of Genoa, Genoa, Italy.

Abstract

Background: In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves.

Methods: 281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP.

Results: The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5-12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in <4% of patients. Age (OR 1.128; p <0.001) and tomographic severity score (OR 1.139; p=0.006) were the only independent predictors of mortality.

Conclusions: Early treatment with CPAP is a safe option for patients with acute hypoxaemic respiratory failure due to COVID-19.