A UK-wide study involving patients at Leicester’s Hospitals has shown that treating patients hospitalised with COVID-19 who have acute respiratory failure using continuous positive airway pressure (CPAP) reduces the need for invasive mechanical ventilation.
Initial data from the RECOVERY-RS trial, which was led by the University of Warwick and Queen’s University Belfast, also suggests that the routine use of high flow nasal oxygenation (HFNO), which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes for patients with COVID-19 when compared with conventional oxygen therapy.
Between April 2020 and May 2021, the randomised controlled trial recruited 72 patients at Glenfield Hospital, with a total of 1,272 patients across the country. It compared the use of CPAP (oxygen and positive pressure delivered via a tightly fitting mask), and HFNO (high pressure oxygen delivered up the nose), against standard care (standard oxygen therapy).
Both CPAP and HFNO interventions are commonly used to treat patients with COVID-19 before they are moved onto invasive ventilation in a critical care bed, should their condition worsen, but it was not known which - if any - resulted in better outcomes.
For each type of treatment, researchers were assessing whether the patient went on to require tracheal intubation (invasive mechanical ventilation in an intensive care unit) or died within 30 days of beginning treatment.
In the comparison of CPAP and conventional oxygen therapy, the likelihood of patients going on to require invasive mechanical ventilation or die within 30 days of treatment was significantly lower in those who were treated with CPAP than those who received standard care. In the CPAP group, 36.3 per cent either needed mechanical ventilation or died within 30 days, compared with 44.4 per cent in the conventional oxygen therapy group.
Based on these results, one person would avoid needing invasive ventilation in an intensive care unit (ICU) for every 12 people treated with CPAP instead of standard oxygen therapy.
Professor Michael Steiner, Consultant Respiratory Physician at Leicester’s Hospitals, Professor of Respiratory Medicine at the University of Leicester and principal investigator for the Leicester site, said:
“The results of the RECOVERY-RS trial are important because they show that using CPAP can be effective at reducing the need for invasive mechanical ventilation for patients with early respiratory failure as a result of COVID-19 infection. This is better for patients and also reduced the pressure on beds in intensive care during the height of the pandemic because in Leicester this was provided by expert nursing and respiratory therapy staff on our respiratory support unit at Glenfield Hospital. Using this evidence, we can help to make sure the right type of respiratory support is available to our patients when it is required. However, this does not mean that mechanical ventilation is no longer sometimes necessary. Indeed for some patients it has been, and continues to be, life-saving.”
Professor Jonathan Van-Tam, Deputy Chief Medical Officer said: “COVID-19 has placed huge pressure on our hospitals and intensive care units, and our doctors, nurses and all NHS staff have stepped up to meet that challenge. A key part of tackling COVID has been the improvements that staff have identified and then implemented in terms of how to best care for COVID patients.
“This study, funded by the NIHR, provides valuable evidence around how non-invasive respiratory support can be used to improve patient outcomes. Reducing invasive mechanical ventilation is better for patients and reduces pressures on mechanical ventilator capacity across the NHS.
“I want to thank the team of doctors, researchers and patient volunteers involved in today’s excellent results – hospitals across the country can now use these data to further improve care for patients and reduce the demand for mechanical ventilation as we get closer to what might still be a challenging winter period.”
The preliminary results of this evaluation of the data are available as a pre-print on medRxiv here and will be submitted to a leading peer-reviewed medical journal.
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For more information - Rachael Dowling, head of research communications, researchcomm@uhl-tr.nhs.uk
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