Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting
Background Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. Limited data are available for patients treated with noninvasive respiratory support outside of...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2021-10-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/7/4/00318-2021.full |
| _version_ | 1818753566808997888 |
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| author | Dominic L. Sykes Michael G. Crooks Khaing Thu Thu Oliver I. Brown Theodore J.P. Tyrer Jodie Rennardson Catherine Littlefield Shoaib Faruqi |
| author_facet | Dominic L. Sykes Michael G. Crooks Khaing Thu Thu Oliver I. Brown Theodore J.P. Tyrer Jodie Rennardson Catherine Littlefield Shoaib Faruqi |
| author_sort | Dominic L. Sykes |
| collection | DOAJ |
| description | Background
Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. Limited data are available for patients treated with noninvasive respiratory support outside of the intensive care setting.
Methods
In this single-centre observational study we observed the characteristics, physiological observations, laboratory tests and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with noninvasive respiratory support outside of the intensive care setting.
Results
We report the outcomes of 140 patients (mean±sd age: 71.2±11.1, 65% male (n=91)) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1 versus 74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2 versus 4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO.
Conclusions
CPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation. |
| first_indexed | 2024-12-18T05:09:24Z |
| format | Article |
| id | doaj.art-b9ee28c9af7543919358ab5bb81c637e |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-18T05:09:24Z |
| publishDate | 2021-10-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-b9ee28c9af7543919358ab5bb81c637e2022-12-21T21:19:56ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-10-017410.1183/23120541.00318-202100318-2021Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care settingDominic L. Sykes0Michael G. Crooks1Khaing Thu Thu2Oliver I. Brown3Theodore J.P. Tyrer4Jodie Rennardson5Catherine Littlefield6Shoaib Faruqi7 Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Hull University Teaching Hospitals NHS Trust, Hull, UK Background Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. Limited data are available for patients treated with noninvasive respiratory support outside of the intensive care setting. Methods In this single-centre observational study we observed the characteristics, physiological observations, laboratory tests and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with noninvasive respiratory support outside of the intensive care setting. Results We report the outcomes of 140 patients (mean±sd age: 71.2±11.1, 65% male (n=91)) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1 versus 74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2 versus 4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO. Conclusions CPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation.http://openres.ersjournals.com/content/7/4/00318-2021.full |
| spellingShingle | Dominic L. Sykes Michael G. Crooks Khaing Thu Thu Oliver I. Brown Theodore J.P. Tyrer Jodie Rennardson Catherine Littlefield Shoaib Faruqi Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting ERJ Open Research |
| title | Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting |
| title_full | Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting |
| title_fullStr | Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting |
| title_full_unstemmed | Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting |
| title_short | Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting |
| title_sort | outcomes and characteristics of covid 19 patients treated with continuous positive airway pressure high flow nasal oxygen outside the intensive care setting |
| url | http://openres.ersjournals.com/content/7/4/00318-2021.full |
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