A recent study has shown that the implementation of an existing treatment can save the lives of patients with the coronavirus disease 2019 (COVID-19). The research, conducted at Lancaster University, was published in the prestigious journal BMJ Respiratory Open.
COVID-19 has led to severe acute respiratory syndrome in many patients diagnosed with the disease, which causes the lungs to swell and collapse. In the beginning stages, continuous positive air pressure (CPAP) was not addressed as a therapy, high-flow nasal oxygen (HFNO) instead being looked at as the primary intervention. CPAP helps to keep the lungs open and allows for easier breathing, with previous trials showing it had a role in improving key outcomes, like progression to intubation and length of stay in intensive care unit (ICU).
The retrospective case-control study involved 206 patients with a confirmed case of COVID-19 and acute respiratory syndrome. The participants received CPAP intervention from ResMed Airsense machines, which are designed to deliver oxygen using a pump within the device. The oxygen levels delivered were at 10-15 L/min via a face mask, which is an estimated 50%–70% of fractional inspired oxygen.
The study found that CPAP was linked to a significantly lower risk of death (HR 0.38, 95% CI 0.36 to 0.40) in patients with a hospital stay of 7 or less days. When CPAP was used within 4 days of a hospital admission, the probability of survival was above 73%. The study also demonstrated how CPAP treatment can be delivered effectively in a ward setting, with little resources across the country as well as worldwide where ICU bed availability is scarce.
“When you use CPAP early in the admission it stops the patient getting worse, therefore avoiding invasive ventilation techniques,” Abdul Ashish, the lead behind the study said. “As CPAP is readily available and can be used in a ward setting, we have demonstrated that, when used early, it can be very effective way of treating severe COVID-19 pneumonia.”
The findings also revealed that the early use of CPAP could potentially reduce lung damage during severe cases of COVID-19 and may also allow patients to recover from inflammatory effects.
“We show that Continuous Positive Airway Pressure (CPAP) in the first days of hospitalization seems to save between 10% to 20% of patients,” Luigi Sedda, another author on the study said. “However, it is important to underline that this was a pilot study with a small sample size, although comforting evidence is starting to emerge elsewhere.”