Reduced ICU demand with early CPAP and proning in COVID-19 at Bradford: a single centre cohort

Lawton, T.; Wilkinson, K. M.; Corp, A.; Javid, R.; MacNally, L.; McCooe, M.; Newton, E.

Background The management of hypoxic respiratory failure due to COVID-19 is not currently subject to consensus. International and national guidance has favoured early intubation, with concerns persisting over the use of CPAP. However, considering available evidence and local circumstances, early ward based CPAP and self proning was adopted in our institution. We aimed to evaluate the safety and efficacy of this approach. Methods In this retrospective observational study we included all patients admitted with a positive COVID-19 PCR. Negative patients were also included where clinical suspicion remained high. A large number of simple CPAP machines were used with entrained oxygen. Ward staff were supported in their use by physiotherapists and an intensive critical care outreach program. CPAP was initiated early via protocol, with the aim of preventing rather than responding to deterioration. Data was analysed descriptively. Results 559 patients admitted prior to 1/May/20 were included. 29.5% received CPAP, 7.2% were admitted to ICU and 4.8% were ventilated. Hospital mortality was 33.3%, ICU mortality 54.5%. Following CPAP, 64% of patients with moderate or severe ARDS at presentation, who were candidates for escalation, avoided intubation during their stay. Conclusion Figures for ICU admission, intubation and overall hospital mortality are significantly lower than those reported in a large and relevant comparator database, whilst ICU mortality is similar. This is despite our population having high levels of co-morbidity and ethnicities associated with poor outcomes. We advocate this approach as both effective and safe.