Early CPAP and HNFC Intervention Reduces Intubation and Mortality Rates After COVID-19 Infection

In the first 24 hours after hospitalization, continuous positive airway pressure (CPAP) in combination with high-flow nasal cannula (HFNC) was associated with a reduction in 30-day mortality and endotracheal intubation (ETI) rates in patients with acute respiratory distress syndrome (ARDS) due to COVID-19 infection, according to one study.

“Despite the theoretical benefits, a priori the profile of a patient requiring such treatment has not yet been described, nor has the ideal time to initiate it. For this reason, our main objective was to study the benefits of administering this combined therapy in the first 24 hours after admission to intermediate respiratory care units (IRCUs),” wrote the researchers. Results of this cohort study were published in Archivos de Bronconeumología.

This study was conducted at a single IRCU center in Madrid, Spain between January 8, 2021, to September 28, 2021, and included a total of 760 patients (aged > 18 years) who were consecutively hospitalized in the IRCU for ARDS due to COVID-19 and treated with HFNC + CPAP. Of these patients, 716 (94.2%) were candidates for ETI, and 380 (50%) were eligible for combined therapy within the first 24 hours of IRCU admission.

Other factors such as sociodemographic, gender, age, obesity, comorbidities, and disease history were reported.

The median age of patients was 57 years (interquartile range [IQR], 47-66). Patients were mostly male (66.1%), the median Charlson Comorbidity Index was 2 (IQR 1-3), and 46.8% were obese. Lastly, the median the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) upon IRCU admission was 95 (IQR 76–126).

As a result, early intervention was associated with a reduction in 30-day mortality rate (8.2% v 15.5%; P = .002), days in the IRCU (6% v 8%; P < .001), days in the emergency hospital (18% v 22%: P < .001), and respiratory therapy duration (5% v 6%; P < .001).

Additionally, early intervention was associated with lower odds of ETI (34.5% v 41.8%; P = .045). Furthermore, early intervention was associated with improved CPAP tolerance against delayed therapy (84% v 71%; P < .001).

The researchers acknowledged that this study had limitations, such as its observational nature and lack of a control group. However, the researchers believe that this study demonstrates the potential of non-invasive respiratory support for patients with ARDS after COVID-19.

“In patients with ARDS secondary to COVID-19, the HFNC + CPAP combination in the first 24 hours was associated with a significant reduction in ETI and 30-day mortality rates compared to initiation on the following days,” concluded the researchers. “Future studies that compare HFNC + CPAP to CPAP or HFNC in monotherapy to treat ARDS would be welcomed.”

Reference

Teran-Tinedo JR, Gonzalez-Rubio J, Najera A, et al. Effect of the early combination of continuous positive airway pressure and high-flow nasal cannula on mortality and intubation rates in patients with COVID-19 and acute respiratory distress syndrome. the duocovid study. Arch Bronconeumol. Published online February 6, 2023. doi:10.1016/j.arbres.2023.01.009