CPAP significantly reduces tracheal intubation risk in COVID-19 patients with respiratory failure: NEJM

In a new study it was found that an initial strategy of continuous positive airway pressure (CPAP) significantly reduced the risk of tracheal intubation or mortality compared to conventional oxygen therapy in patients with acute hypoxemic respiratory failure caused by COVID-19, but there was no significant difference between an initial strategy of high-flow nasal oxygen (HFNO) and conventional oxygen therapy.

This study was conducted by Gavin D. Perkins and team with the objective to see if CPAP or HFNO improves clinical outcomes in hospitalized patients with COVID-19-related acute hypoxemic respiratory failure as compared to standard oxygen treatment. The findings of this study were published in the Journal of American Medical Association.

This study was a parallel group, adaptive, randomized clinical trial of 1273 hospitalized patients with COVID-19–related acute hypoxemic respiratory failure was conducted in this investigation. The experiment took place between April 6, 2020, and May 3, 2021, at 48 acute care hospitals in the United Kingdom and Jersey. The last follow-up was place on June 20, 2021. Adult patients were randomly assigned to one of three groups: CPAP (n = 380), HFNO (n = 418), or standard oxygen treatment (n = 475). The primary outcome was either tracheal intubation or death within 30 days.

The key findings of this work were as follow:

1. Because to falling COVID-19 case counts in the UK and the conclusion of the sponsored recruiting period, the experiment was terminated prematurely.

2. Primary outcome data were obtained for 1260 of the 1273 randomized individuals. 17.% of individuals switched between interventions.

3. The need for tracheal intubation or death within 30 days was considerably reduced with CPAP compared to conventional oxygen therapy, but not statistically different with HFNO vs conventional oxygen therapy.

4. Adverse events occurred in 34.2 percent (130/380) of CPAP individuals, 20.6% (86/418) of HFNO participants, and 13.9% (66/475) of conventional oxygen treatment participants.

In conclusion, the trial may have been underpowered to compare HFNO with standard oxygen treatment, and early study termination and group crossover should be considered when interpreting the data.

Reference:

Perkins GD, Ji C, Connolly BA, et al. Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial. JAMA. Published online January 24, 2022. doi:10.1001/jama.2022.0028