Background NHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling of care. However, data assessing this strategy are sparse, especially for the use of CPAP as a ceiling of care, and particularly when delivered outside of a traditional critical care environment. We describe a cohort of patients from Liverpool, UK, who received CPAP on a dedicated respiratory surge unit at the start of the second wave of the COVID-19 pandemic in UK. Methods Retrospective cohort analysis of consecutive patients receiving CPAP for the treatment of respiratory failure secondary to COVID-19 on the respiratory surge unit at the Royal Liverpool Hospital, Liverpool, UK from 21 September until 30 November 2020. Results 88 patients were included in the analysis. 56/88 (64%) were deemed suitable for escalation to invasive mechanical ventilation (IMV) and received CPAP as a trial; 32/88 (36%) received CPAP as a ceiling of care. Median age was 63 years (IQR: 56–74) and 58/88 (66%) were men. Median SpO2/FiO2 immediately prior to CPAP initiation was 95 (92–152). Among patients for escalation to IMV, the median time on CPAP was 6 days (IQR 4–7) and survival at day 30 was 84% (47/56) with 14/56 (25%) escalated to IMV. Of those patients for whom CPAP was ceiling of care, the median duration of CPAP was 9 days (IQR 7–11) and 18/32 (56%) survived to day 30. Pulmonary barotrauma occurred in 9% of the cohort. There were no associations found on multivariant analysis that were associated with all-cause 30-day mortality. Conclusions With adequate planning and resource redistribution, CPAP may be delivered effectively outside of a traditional critical care setting for the treatment of respiratory failure due to COVID-19. Clinicians delivering CPAP to patients with COVID-19 pneumonitis should be alert to the dangers of pulmonary barotrauma. Among patients who are for escalation of care, the use of CPAP may avoid the need for IMV in some patients. Our data support the NHS England recommendation to consider CPAP as a ceiling of care. Data are available upon reasonable request.

中文翻译：

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在第二波 COVID-19 期间，CPAP 在重症监护之外提供服务：英国呼吸急骤病房的结果


背景英国 NHS 建议将无创持续气道正压通气 (CPAP) 作为治疗与 COVID-19 肺炎相关的 1 型呼吸衰竭的可能方法，以避免插管或作为护理上限。然而，评估这一策略的数据很少，特别是对于使用 CPAP 作为护理上限，尤其是在传统重症监护环境之外提供时。我们描述了来自英国利物浦的一组患者，他们在英国第二波 COVID-19 大流行开始时通过专用呼吸急速装置接受了 CPAP 治疗。方法 对 2020 年 9 月 21 日至 11 月 30 日期间在英国利物浦皇家利物浦医院呼吸急速病房接受 CPAP 治疗继发于 COVID-19 的呼吸衰竭的连续患者进行回顾性队列分析。结果 88 名患者纳入分析。 56/88 (64%) 被认为适合升级至有创机械通气 (IMV) 并接受 CPAP 作为试验； 32/88 (36%) 接受 CPAP 作为护理上限。中位年龄为 63 岁（IQR：56-74），其中 58/88 (66%) 为男性。开始 CPAP 之前的中位 SpO2/FiO2 为 95 (92–152)。在升级至 IMV 的患者中，CPAP 治疗的中位时间为 6 天 (IQR 4-7)，第 30 天的生存率为 84% (47/56)，其中 14/56 (25%) 升级至 IMV。在 CPAP 治疗上限的患者中，CPAP 的中位持续时间为 9 天 (IQR 7-11)，18/32 (56%) 存活到第 30 天。该队列中 9% 的人发生肺气压伤。多变量分析未发现与 30 天全因死亡率相关的关联。 结论 通过充分的规划和资源重新分配，可以在传统重症监护环境之外有效地提供 CPAP 来治疗 COVID-19 引起的呼吸衰竭。为 COVID-19 肺炎患者提供 CPAP 治疗的临床医生应警惕肺气压伤的危险。在需要升级护理的患者中，使用 CPAP 可能会避免某些患者需要 IMV。我们的数据支持英国国民医疗服务体系 (NHS England) 将 CPAP 视为护理上限的建议。数据可根据合理要求提供。