COVID-19 Care: CPAP Machines Can Help In Management of COVID-19 Respiratory Failure When Used In Early Stages

COVID-19 Care: Doctors and researchers from Edge Hill University, Lancashire-UK, Lancaster University-UK, and hospitals under the Wrightington Wigan and Leigh NHS Foundation Trust-UK have in a new study found that CPAP Machines when used in early stages can save the lives of patients hospitalized with COVID-19. This is especially important as the current surges in the second wave is already overwhelming healthcare facilities and hospitals and once again a shortage of ventilators, oxygen supplies etc are materializing despite incompetent governments in certain developed countries mentioning that they were prepared and had ample supplies.


 
The study findings were published in the peer reviewed journal:  BMJ Open Respiratory Research. https://bmjopenrespres.bmj.com/content/7/1/e000692
 
The research team led by Dr Abdul Ashish from Edge Hill University and Dr Luigi Sedda from Lancaster University together with the team at Wrightington, Wigan and Leigh Teaching Hospitals NHS Trust (WWL) conducted a study to evaluate the role of continuous positive air pressure (CPAP) in the management of respiratory failure associated with COVID-19 infection. Early clinical management with limited use of CPAP (3% of patients) was compared with a later clinical management strategy which had a higher proportion of CPAP use (15%).
 
The study was such that it was a retrospective case-controlled service evaluation for a single UK National Health Service (NHS) Trust during March–June 2020 designed and conducted solely to estimate the effects of current care.
 
A total of 206 patients with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 and 3 April 2020 for the early group (controls), and between 10 April 2020 and 11 May 2020 for the late group (cases). Follow-up for all cases was until 11 June by which time all patients had a final outcome of death or discharge. Both groups were composed of 103 patients. Cases and controls were matched by age and sex.
 
CPAP was found to be significantly (HR 0.38, 95% CI 0.36 to 0.40) associated with lower risk of death in patients with hospital stay equal to, or below 7 days.
 
However, for longer hospitalization CPAP was found to be associated with increased risk of death (HR 1.72, 95% CI 1.40 to 2.12). When CPAP was initiated within 4 days of hospital admission, the survival probability was above 73% (95% CI 53% to 99%).
 
In addition, lower A-a gradient was associated with lower risk of death in CPAP patients (HR 1.011, 95% CI 1.010 to 1.013). The selected model (best fit) was stratified by sex and clustered by case/control groups. The predictors were age, intubation, hypertension and the residency from care homes, which were found to be statistically significantly associated with patient’s death/discharge.
 
Dr Sedda told Thailand Medical News, “We show that Continuous Positive Airway Pressure (CPAP) in the first days of hospitalization seems to save between 10% to 20% of patients. However, it is important to underline that this was a pilot study with a small sample size, although comforting evidence is starting to e merge elsewhere.”
 
Based on reports from NHS England, 96% of people who died with COVID had at least one serious health condition and the majority are over the age of 80.
 
The study team used the CPAP machines on patients with COVID-19 admitted to the Royal Albert Edward Infirmary in Wigan.
 
It was found that In the case of patients with severe acute respiratory syndrome, COVID-19 may cause the lungs to swell and collapse. Using CPAP treatment, which is often used at home to help people with sleep problems, helps to keep the lungs open and makes breathing easier.

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The study conducted by the team showed how CPAP treatment can be delivered effectively in a ward setting, with low resources both across the country and worldwide where intensive care bed availability is limited.
 
Importantly, the research has so far helped almost a hundred patients at the Royal Albert Edward Infirmary.
 
Respiratory Physician Dr Ashish said, “When you use CPAP early in the admission it stops the patient getting worse, therefore avoiding invasive ventilation techniques. 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. We are one of the early adopters of ward based CPAP in the North West and have developed local protocols and pathways by modifying our existing CPAP machines to deliver good outcomes for our patients.”
 
The study team also found that the early use of CPAP potentially reduces lung damage during the worst of the COVID-19 infection and allows the patient to recover from the inflammatory effects. However, when used later, CPCP does not prevent lung damage thus leading to additional inflammation and a reduction in survival chances.
 
Associate Medical Director Dr Martin Farrier from Wrightington Wigan and Leigh NHS Foundation Trust said, ”We are at the forefront of developing care for COVID-19 patients and have developed a very effective treatment strategy for our population who develop lung failure following COVID-19 infection. The people of Wigan can be sure that they are going to get the best care at WWL because we have helped to develop the best care.”
 
Dr Farrier He praised Dr Sedda and his team at Lancaster University saying, “This collaboration with Lancaster University has been remarkable and allowed us to deliver high quality research. The BMJ Respiratory Open is a very significant journal, but more than that, the results of the work are important in terms of our response to COVID-19 and for our organization. This is the most important publication on the use of CPAP in treating COVID-19 patients and shows a significant association with a fall in mortality. The way that we treat patients here in Wigan has been influential in the way that patients are now treated in other organizations.”
 
The study team concluded, “CPAP is a simple and cost-effective intervention. It has been established for care of other respiratory disorders but not for COVID-19 respiratory failure. This evaluation establishes that CPAP as a potentially viable treatment option for this group of patients during the first days of hospital admission. As yet there is limited availability of quantitative research on CPAP use for COVID-19. Whist this work is hampered by both the relatively small sample size and retrospective design (which reduced the ability to control potential confounders), it represents evidence of the significant benefit of early CPAP intervention. This evaluation should stimulate further research questions and larger study designs on the potential benefit of CPAP for COVID-19 infections. Globally, this potentially beneficial low cost and low intensity therapy could have added significance economically for healthcare provision in less developed countries.
 
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