CPAP reduces the risk of tracheal intubation or death compared with conventional oxygen therapy in COVID-19 patients with acute hypoxemic respiratory failure, according to a study published in the Journal of the American Medical Association.
Noninvasive respiratory strategies such as CPAP and high-flow nasal oxygen (HFNO) have been recommended for patients with COVID-19 with acute hypoxemic respiratory failure as a means of avoiding invasive mechanical ventilation. Nevertheless, concerns linger regarding whether these strategies serve to delay tracheal intubation and exacerbate lung injury for a proportion of patients.
To address these concerns, researchers conducted a clinical trial of 1273 patients at 48 hospitals across the United Kingdom to compare CPAP (n=380), HFNO (n=418), and conventional oxygen therapy (n=475) in patients hospitalized with COVID-19 with acute hypoxemic respiratory failure. The primary outcome was a composite of tracheal intubation or mortality within 30 days. The trial was conducted between April 2020 and May 2021, with final follow-up in June 2021.
Crossover between interventions occurred in 17.1% of participants (15.3% in the CPAP group; 11.5% in the HFNO group; 23.6% in the conventional oxygen therapy group). The researchers found that the need for tracheal intubation or mortality within 30 days was significantly lower with CPAP vs conventional oxygen therapy (36.3% vs 44.4%; P =.03), but not significantly different with HFNO vs conventional oxygen therapy (44.3% vs 45.1%; P =.83). Adverse events occurred in 34.2% of participants in the CPAP group, 20.6% in the HFNO group, and 13.9% in the conventional oxygen therapy group.