CPAP Use in Covid 19 Patients: A Retrospective Observational Study in the Emergency Department.

BackgroundDuring COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Study design and MethodsA retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. ResultsA total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16-37] vs 15 days [IQR 9-17] (p=0.005). The median invasive mechanical ventilation time was 11 days [IQR 7-21] with an ICU length of stay of 14.5 days [IQR 10-28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p=0.003) and respiratory rate (RR) (p=0.059).ConclusionsA short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s SpO2 improvement and RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.