Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation.

COVID-19 Ceiling of care Invasive mechanical ventilation Non-invasive ventilation Oxygen nIMV

Journal

EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727

Informations de publication

Date de publication:
Oct 2021
Historique:
pubmed: 14 9 2021
medline: 14 9 2021
entrez: 13 9 2021
Statut: ppublish

Résumé

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. This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1 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. 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. L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.

Sections du résumé

BACKGROUND 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 METHODS
This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1
FINDINGS RESULTS
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 CONCLUSIONS
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 BACKGROUND
L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.

Identifiants

DOI: 10.1016/j.eclinm.2021.101122 PMID: 34514360 PMC: PMC8424135
pubmed: 34514360
doi: 10.1016/j.eclinm.2021.101122
pii: S2589-5370(21)00402-8
pmc: PMC8424135
doi:

Types de publication

Journal Article

Langues

eng

Pagination

101122

Subventions

Organisme : Medical Research Council
ID : MR/R00191X/1
Pays : United Kingdom

Informations de copyright

© 2021 The Authors.

Déclaration de conflit d'intérêts

AB reports fees for speaking/session chair for Fisher and Paykel webinars (high nasal flow cannulae). AB is an advisory board member for Sanofi Genzyme (respiratory management of Pompe disease). All other authors have nothing to declare.

Auteurs

P Bradley (P)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
NWCORR North West Collaborative Organisation for Respiratory Research.

J Wilson (J)

Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

R Taylor (R)

Research and Development, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

J Nixon (J)

Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
NWCORR North West Collaborative Organisation for Respiratory Research.

J Redfern (J)

Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

P Whittemore (P)

Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

M Gaddah (M)

Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.

K Kavuri (K)

Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.

A Haley (A)

Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.

P Denny (P)

Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.

C Withers (C)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

R C Robey (RC)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

C Logue (C)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

N Dahanayake (N)

Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

D Siaw Hui Min (DSH)

Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

J Coles (J)

Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

M S Deshmukh (MS)

Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

S Ritchie (S)

Department of infectious diseases and tropical medicine. North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

M Malik (M)

Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

H Abdelaal (H)

Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

K Sivabalah (K)

Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

M D Hartshorne (MD)

Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.

D Gopikrishna (D)

Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.

A Ashish (A)

Respiratory department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.

E Nuttall (E)

Respiratory department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.

A Bentley (A)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK.

T Bongers (T)

Respiratory department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

T Gatheral (T)

Respiratory department, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.

T W Felton (TW)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK.

N Chaudhuri (N)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK.

L Pearmain (L)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
NWCORR North West Collaborative Organisation for Respiratory Research.
Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.

Classifications MeSH