New CPAP recommendations for COVID patients
18 October 2021
The National COVID-19 Clinical Evidence Taskforce has today announced new recommendations for the use of CPAP and high-flow nasal oxygen in hypoxaemic COVID patients.
The Hospital and Acute Care Panel have incorporated the results of the recent RECOVERY-Respiratory Support trial (Perkins et al.) into the evidence base for respiratory support. The previous recommendation for High flow nasal oxygen therapy (HFNO) was based on indirect evidence but with the additional randomised trial data the Taskforce has revised the conditional recommendation to:
Consider using continuous positive airway pressure (CPAP) therapy for patients with persistent hypoxaemia (defined as requiring an FiO2 ≥ 0.4 to maintain SpO2 in their target range) associated with COVID-19. Adjust positive end-expiratory pressure as required, most patients require pressures of 10 to 12 cm. Excessive pressures may increase the risk of pneumothorax. Adjust oxygen to maintain SpO2 in the target range, FiO2 0.4 to 0.6.
Patients requiring CPAP for COVID-19 pneumonia are at high risk of further deterioration, requiring intubation and mechanical ventilation. Liaise with ICU and monitor closely for deterioration.
If CPAP is not available or not tolerated, consider HFNO as an alternative using the same safety parameters as CPAP.