TY - JOUR T1 - The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00365-2022 VL - 9 IS - 2 SP - 00365-2022 AU - Claudia Brusasco AU - Francesco Corradi AU - Federico Dazzi AU - Alessandro Isirdi AU - Chiara Romei AU - Andrea Parisini AU - Silvia Boni AU - Gregorio Santori AU - Vito Brusasco AU - the Galliera CPAP-COVID-19 study group AU - the Galliera CPAP-COVID-19 study group AU - C. Brusasco AU - F. Corradi AU - C. Brusasco AU - A. Isirdi AU - F. Dazzi AU - V. Brusasco AU - A. Parisini AU - S. Boni AU - G. Santori AU - A. Parisini AU - S. Boni AU - F. Corradi AU - C. Brusasco AU - C. Romei AU - F. Corradi AU - C. Brusasco AU - V. Brusasco AU - F. Corradi AU - C. Brusasco AU - G. Santori AU - F. Dazzi Y1 - 2023/03/01 UR - http://openres.ersjournals.com/content/9/2/00365-2022.abstract N2 - 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 hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. 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 mortality.Conclusions Early treatment with CPAP is a safe option for patients with acute hypoxaemic respiratory failure due to COVID-19.CPAP with high-flow output is a valid and safe option for respiratory support before intubation of patients with AHRF due to COVID-19 pneumonia. CPAP does not appear to be associated with high barotrauma risk or detrimental effect on eventual IMV. https://bit.ly/3hCqybZ ER -