COVID-19 and acute respiratory failure treated with CPAP

Introduction: Patients admitted with COVID-19 often have severe hypoxemic respiratory insufficiency and it can be difficult to maintain adequate oxygenation with oxygen supplementation alone. There is a physiological rationale for the use of Continuous Positive Airway Pressure (CPAP), and CPAP could...

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Main Authors: Linette Marie Kofod, Klaus Nielsen Jeschke, Morten Tange Kristensen, Rikke Krogh-Madsen, Carsten Monefeldt Albek, Ejvind Frausing Hansen
Format: Article
Language:English
Published: Taylor & Francis Group 2021-01-01
Series:European Clinical Respiratory Journal
Subjects:
Online Access:http://dx.doi.org/10.1080/20018525.2021.1910191
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spelling doaj-30ea5a1deb0c4ed3b955954fc7ce37982021-04-21T16:14:25ZengTaylor & Francis GroupEuropean Clinical Respiratory Journal2001-85252021-01-018110.1080/20018525.2021.19101911910191COVID-19 and acute respiratory failure treated with CPAPLinette Marie Kofod0Klaus Nielsen Jeschke1Morten Tange Kristensen2Rikke Krogh-Madsen3Carsten Monefeldt Albek4Ejvind Frausing Hansen5Copenhagen University Hospital- Hvidovre&Physical Medicine and Rehabilitation ResearchCopenhagen University HospitalCopenhagen University Hospital- Hvidovre&Physical Medicine and Rehabilitation ResearchCopenhagen University HospitalCopenhagen University Hospital - Hvidovre & University of CopenhagenCopenhagen University HospitalIntroduction: Patients admitted with COVID-19 often have severe hypoxemic respiratory insufficiency and it can be difficult to maintain adequate oxygenation with oxygen supplementation alone. There is a physiological rationale for the use of Continuous Positive Airway Pressure (CPAP), and CPAP could keep some patients off mechanical ventilation. We aimed to examine the physiological response to CPAP and the outcome of this treatment. Methods: Data from all patients admitted with COVID-19 and treated with CPAP, from March to July 2020 were collected retrospectively. CPAP was initiated on a medical ward when oxygen supplementation exceeded 10 liters/min to maintain oxygen saturation (SpO2) ≥92%. CPAP was administered with full face masks on a continuous basis until stable improvement in oxygenation or until intubation or death. Results: CPAP was initiated in 53 patients (35 men, 18 women) with a median (IQR) age of 68 (57–78) years. Nine patients were not able to tolerate the CPAP treatment. Median duration for the 44 patients receiving CPAP was 3 (2–6) days. The PaO2/FiO2 ratio was severely reduced to an average of 101 mmHg at initiation of treatment. A positive response of CPAP was seen on respiratory rate (p = 0.002) and on oxygenation (p < 0.001). Of the 44 patients receiving CPAP, 12 (27%) avoided intubation,13 (29%) were intubated, and 19 (43%) died. Of the patients with a ceiling of treatment in the ward (26 of 53) only 2 survived. Older age and high initial oxygen demand predicted treatment failure. Discussion: CPAP seems to have positive effect on oxygenation and respiratory rate in most patients with severe respiratory failure caused by COVID-19. Treatment with CPAP to severely hypoxemic patients in a medical ward is possible, but the prognosis for especially elderly patients with high oxygen requirement and with a ceiling of treatment in the ward is poor.http://dx.doi.org/10.1080/20018525.2021.1910191coronavirus diseasecontinuous positive airway pressurephysiotherapynoninvasive ventilationhypoxemia
collection DOAJ
language English
format Article
sources DOAJ
author Linette Marie Kofod
Klaus Nielsen Jeschke
Morten Tange Kristensen
Rikke Krogh-Madsen
Carsten Monefeldt Albek
Ejvind Frausing Hansen
spellingShingle Linette Marie Kofod
Klaus Nielsen Jeschke
Morten Tange Kristensen
Rikke Krogh-Madsen
Carsten Monefeldt Albek
Ejvind Frausing Hansen
COVID-19 and acute respiratory failure treated with CPAP
European Clinical Respiratory Journal
coronavirus disease
continuous positive airway pressure
physiotherapy
noninvasive ventilation
hypoxemia
author_facet Linette Marie Kofod
Klaus Nielsen Jeschke
Morten Tange Kristensen
Rikke Krogh-Madsen
Carsten Monefeldt Albek
Ejvind Frausing Hansen
author_sort Linette Marie Kofod
title COVID-19 and acute respiratory failure treated with CPAP
title_short COVID-19 and acute respiratory failure treated with CPAP
title_full COVID-19 and acute respiratory failure treated with CPAP
title_fullStr COVID-19 and acute respiratory failure treated with CPAP
title_full_unstemmed COVID-19 and acute respiratory failure treated with CPAP
title_sort covid-19 and acute respiratory failure treated with cpap
publisher Taylor & Francis Group
series European Clinical Respiratory Journal
issn 2001-8525
publishDate 2021-01-01
description Introduction: Patients admitted with COVID-19 often have severe hypoxemic respiratory insufficiency and it can be difficult to maintain adequate oxygenation with oxygen supplementation alone. There is a physiological rationale for the use of Continuous Positive Airway Pressure (CPAP), and CPAP could keep some patients off mechanical ventilation. We aimed to examine the physiological response to CPAP and the outcome of this treatment. Methods: Data from all patients admitted with COVID-19 and treated with CPAP, from March to July 2020 were collected retrospectively. CPAP was initiated on a medical ward when oxygen supplementation exceeded 10 liters/min to maintain oxygen saturation (SpO2) ≥92%. CPAP was administered with full face masks on a continuous basis until stable improvement in oxygenation or until intubation or death. Results: CPAP was initiated in 53 patients (35 men, 18 women) with a median (IQR) age of 68 (57–78) years. Nine patients were not able to tolerate the CPAP treatment. Median duration for the 44 patients receiving CPAP was 3 (2–6) days. The PaO2/FiO2 ratio was severely reduced to an average of 101 mmHg at initiation of treatment. A positive response of CPAP was seen on respiratory rate (p = 0.002) and on oxygenation (p < 0.001). Of the 44 patients receiving CPAP, 12 (27%) avoided intubation,13 (29%) were intubated, and 19 (43%) died. Of the patients with a ceiling of treatment in the ward (26 of 53) only 2 survived. Older age and high initial oxygen demand predicted treatment failure. Discussion: CPAP seems to have positive effect on oxygenation and respiratory rate in most patients with severe respiratory failure caused by COVID-19. Treatment with CPAP to severely hypoxemic patients in a medical ward is possible, but the prognosis for especially elderly patients with high oxygen requirement and with a ceiling of treatment in the ward is poor.
topic coronavirus disease
continuous positive airway pressure
physiotherapy
noninvasive ventilation
hypoxemia
url http://dx.doi.org/10.1080/20018525.2021.1910191
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