Study Finds Benefit in Positive Airway Pressure for Hospitalised COVID Patients

Patients hospitalised with COVID-19 were less likely to need tracheal intubation when they received continuous positive airway pressure (CPAP) treatment, researchers said.

Preliminary data from a study also found there was no benefit from using high flow nasal oxygenation (HFNO) over standard oxygen delivery.

Researchers from the Respiratory Strategies in COVID-19, CPAP, High-flow, and Standard Care (Recovery-RS) trial, led by the University of Warwick and Queen's University Belfast, said the findings could help relieve pressure on hospital intensive care resources.

Treatment Options Should Be 'Reconsidered'

The preprint study compared CPAP, HFNO, and conventional oxygen therapy in patients with suspected or confirmed COVID in 48 UK hospitals.

Gavin Perkins, a professor in critical care medicine at Warwick, who led the study, said: "The routine use of high flow nasal oxygenation, which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes.

"By giving patients the most effective treatment to begin with, we can help prevent resource shortages in our NHS and make sure the right type of ventilation is available to patients when it is required."

The investigation, over a 13 month period between April 2020 and May 2021, looked at outcomes of 1272 hospitalised adults who experienced acute respiratory failure after developing symptoms of COVID-19.

Participants were randomly allocated to receive one of the three respiratory support interventions during their care in hospital.

Of those:

29.9% received CPAP
32.8% received HFNO
37.3% received conventional oxygen therapy

The study investigated the proportion of people in each group who went on to require invasive mechanical ventilation or died within 30 days of treatment.

This applied to 36.3% of those in the CPAP cohort, compared with 44.4% of those receiving conventional oxygen therapy. There was no difference in primary outcomes between patients in the HFNO and conventional oxygen therapy groups.

The scientists interpreted the results as meaning one person would avoid needing invasive ventilation within intensive care units for every 12 people treated with CPAP instead of standard oxygen therapy.

Reducing Pressure on NHS Services

Prof Jonathan Van-Tam, England's deputy chief medical officer, commented that the study had provided "valuable evidence around how non-invasive respiratory support can be used to improve patient outcomes", adding that reducing the need for invasive ventilation was "better for patients, and reduces pressures on mechanical ventilator capacity across the NHS".

Prof Lucy Chappell, chief scientific officer for the Department of Health and Social Care, commented: "These data will help ensure hospitalised patients with COVID-19 get the best possible care, making a difference to patients and intensive care units across the country."

Prof Simon Ball, executive medical officer at University Hospitals Birmingham said: "This is an important study that will significantly influence treatment decisions. It is an example of how well NHS hospitals can deliver studies to improve clinical practice. This includes the definition of treatments that are beneficial, in this case CPAP, but just as importantly those with no apparent benefit."

The study was funded by the National Institute for Health Research.

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