P184 Is continuous positive airway pressure (CPAP) effective in the management of COVID-19 in patients aged 75 and over? A retrospective observational study of a respiratory COVID-19 CPAP unit through its second wave

Abstract

IntroductionThere remains significant variation in treatment of COVID-19 associated respiratory failure. Although Continuous Positive Airway Pressure (CPAP) has shown to improve outcome in single centre studies, inclusion criteria for commencement of CPAP varies significantly (Ashish et al., 2020;Nightingale et al., 2020). This respiratory-led ward-level dedicated CPAP unit provided CPAP to COVID-19 patients through the ‘second wave’. This study aims to evaluate the efficacy and appropriateness of CPAP for COVID-19 management in an elderly population.MethodsThis retrospective observational study included all patients aged 75 and over who received CPAP for COVID-19 infection, admitted to a district general hospital between 1 October 2020 and 16 February 2021. Fifty-seven patients were included. Data were collected from computerised clinical notes for analysis.ResultsOf 57 patients (39 male and mean age 80), 47 (82.5%) patients died during admission or within 5 days of discharge. 10 (17.5%) patients survived to discharge. Non-survivors had a median CFS of 4;IQR 3–5, as did survivors (median CFS 4;IQR 3–4). Non-survivors had a median of 3 (IQR 2–4) significant comorbidities, and survivors had 2.5 (IQR 2–3.8). Median P/F (PaO2/FiO2) ratio prior to commencing CPAP was 10.5 (IQR 8.4–12.6) for non-survivors and 14.4 (IQR 12.9–18.8) for survivors. The odds of death were 6.8 (p value <0.01) in those with a severe P/F ratio (<13.3).ConclusionThis evidence indicates that CPAP used in patients aged 75 and over, particularly those with a severe P/F ratio prior to commencing CPAP, does not improve mortality. These findings can inform future decision-making and CPAP protocol development to potentially limit its use in this group. Further study of less invasive alternative management options, such as nasal high flow oxygen, is recommended.