Continuous positive airway pressure face-mask ventilation to manage massive influx of patients requiring respiratory support during the SARS-CoV-2 outbreak

  1. S. Alviset
  2. Q. Riller
  3. J. Aboab
  4. K. Dilworth
  5. PA. Billy
  6. Y. Lombardi
  7. M. Azzi
  8. L. Ferreira Vargas
  9. L. Laine
  10. M. Lermuzeaux
  11. N. Memain
  12. D. Silva
  13. T. Tchoubou
  14. D. Ushmorova
  15. H. Dabbagh
  16. S. Escoda
  17. R. Lefrançois
  18. A. Nardi
  19. A. Ngima
  20. V. Ioos
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Abstract

Background

Since December 2019, a global outbreak of coronavirus disease (COVID-19) is responsible for massive influx of patients with acute respiratory failure in hospitals. We describe the characteristics, clinical course, and outcomes of COVID-19 patients treated with continuous positive airway pressure (CPAP) in a large public hospital in France.

Method

It is a single centre retrospective observational cohort. From 27th March to 23rd April, consecutive patients who had signs of respiratory failure or were unable to maintain an SpO2 > 90%, despite receiving 10 to 15 l/min of oxygen with a non-rebreather mask, were treated by CPAP with a face-mask unless the ICU physician judged that immediate intubation was indicated. The main outcomes under study were reasons for CPAP discontinuation and mortality.

Results

A total of 585 patients were admitted in Delafontaine hospital for severe COVID-19. ICU was quickly overwhelmed. Fifty-nine out of 159 (37%) patients requiring ICU care had to be referred to other hospitals. CPAP therapy was initiated in 49 patients and performed out of ICU in 41 (84%). SARS-CoV2 pneumonia was confirmed by PCR from respiratory tract in 39 (79%) patients and by thoracic CT scan in the remaining patients. CPAP was performed out of ICU in 41 (84%) cases. Median age was 65 years (IQR=54-71). Median duration of CPAP treatment was 3 days (IQR=1-5). Reasons for discontinuation of CPAP were intubation for invasive ventilation in 25 (51%) patients, improvement in 16 (33%), poor tolerance in 6 (12%) and death in 2 (4%). A decision not to intubate had been taken for the 2 patients who died while on CPAP.

Conclusions

Treatment with CPAP is feasible and safe in a non-ICU environment in the context of a massive influx of patients. One third of these patients with high oxygen requirements did not eventually need invasive ventilation.

Key messages

What is the key question?

What is the best respiratory support strategy to manage a massive influx of patients with hypoxemic respiratory failure despite high-flow oxygen delivered with a non-rebreather mask?

What is the bottom line?

Continuous positive airway pressure face mask ventilation delivered in non-ICU wards to patients who do not require immediate intubation is feasible and safe.

Why read on?

Face mask ventilation with CPAP should be considered as an option of respiratory support in the context of the on-going COVID-19 pandemic and limited availability of ICU beds.

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