LAUSR

Introduction: COVID-19 often results in acute adult respiratory distress syndrome (ARDS) (Jin-Gen Xia et al 2020) Current guidelines support that continuous positive airway pressure (CPAP) can be used as a bridge to invasive ventilation or as a ceiling of care in patients with a high clinical frailty score (CSF) We present the results of patients treated with CPAP in the specialist respiratory wards of a large hospital in the UK Methods: 45 patients were trialled on CPAP over a two-month period CPAP was started when patients required more than 10L/min of oxygen to maintain saturation above 92% Results: The mean age was 63 years and 80% were males In 10 patients (22%), ceiling of care was CPAP only in view of CSF The mean Pa02/Fi02 ratio was 104 Mean PEEP was 10 cms and mean Fi02 66% Overall 42% were successfully treated with CPAP (average duration 79 hours) and discharged home 37% deteriorated requiring invasive ventilation (average of 30 hours CPAP pre intubation) Among those who required ICU admission 20% died, 33% were discharged home and 47% continue to be treated in hospital In those who had CPAP as ceiling of care, 90% died Those with successful CPAP alone had an average length of hospital stay of 11 days Discussion: CPAP was used as a first line of ventilatory support for patients who could be categorised as moderately severe ARDS by Berlin criteria 42% patients were discharged home with a short length of stay The outcome of patients with CPAP as ceiling of care was poor in view of significant co-morbidities Our data suggests CPAP can be used as first line of treatment with good outcomes Larger studies/meta analyses are indicated to delineate this further