PT - JOURNAL ARTICLE AU - Brusasco, Claudia AU - Corradi, Francesco AU - Dazzi, Federico AU - Isirdi, Alessandro AU - Romei, Chiara AU - Parisini, Andrea AU - Boni, Silvia AU - Santori, Gregorio AU - Brusasco, Vito AU - , TI - On the use of continuous positive airway pressure during the second and third waves of the Covid-19 pandemic AID - 10.1183/23120541.00365-2022 DP - 2022 Jan 01 TA - ERJ Open Research PG - 00365-2022 4099 - http://openres.ersjournals.com/content/early/2022/11/10/23120541.00365-2022.short 4100 - http://openres.ersjournals.com/content/early/2022/11/10/23120541.00365-2022.full AB - Background In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves.Methods 281 COVID-19 patients with moderate-to-severe acute hypoxemic respiratory failure (158 full-code and 123 do-not-intubate, DNI), were managed with high-flow CPAP early in their hospitalization. IMV was considered after 4 days of unsuccessful CPAP.Results The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in <4% of patients. Age (OR=1.128; p <0.001) and tomographic severity score (OR=1.139; p=0.006) were the only independent predictors of mortalityConclusions Early treatment with CPAP is a safe option for patients with acute hypoxemic respiratory failure due to COVID-19.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Competing interests: The authors declare that they have no competing interests with the subject of the article.