PDF(Pubmed)
Abstract：
Continuous positive airway pressure (CPAP) has been increasingly deployed to manage patients with COVID-19 and acute respiratory failure, often for protracted periods. However, concerns about protracted CPAP have been raised. This study aimed to examine the use of CPAP for patients with COVID-19 and the outcomes after protracted use.
This was a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from March 1, 2020 to December 25, 2021 who received CPAP. Protracted CPAP was defined as ≥ 5 continuous days of CPAP. Outcomes included CPAP failure rate (institution of invasive mechanical ventilation [IMV] or death), mortality, and outcomes after institution of IMV. Multivariable logistic regression was performed to assess the impact of protracted CPAP on mortality after IMV.
A total of 1961 patients with COVID-19 received CPAP for COVID-19 pneumonitis, with 733 patients (37.4%) receiving protracted CPAP. CPAP failure occurred in 891 (45.4%): 544 patients (27.7%) received IMV and 347 patients (17.7%) died in critical care without IMV. Hospital mortality rate was 41.3% for the population. For patients who subsequently commenced IMV, hospital mortality was 58.7% for the standard duration CPAP group and 73.9% for the protracted duration CPAP group (P=0.003); however, there was no statistical difference in hospital mortality after adjustment for confounders (odds ratio 1.4, 95% confidence interval 0.84-2.33, P=0.195).
Protracted CPAP was used frequently for managing patients with COVID-19. Whilst it was not associated with worse outcomes for those patients who subsequently required IMV, this might be due to residual confounding and differences in processes of care.
This was a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from March 1, 2020 to December 25, 2021 who received CPAP. Protracted CPAP was defined as ≥ 5 continuous days of CPAP. Outcomes included CPAP failure rate (institution of invasive mechanical ventilation [IMV] or death), mortality, and outcomes after institution of IMV. Multivariable logistic regression was performed to assess the impact of protracted CPAP on mortality after IMV.
A total of 1961 patients with COVID-19 received CPAP for COVID-19 pneumonitis, with 733 patients (37.4%) receiving protracted CPAP. CPAP failure occurred in 891 (45.4%): 544 patients (27.7%) received IMV and 347 patients (17.7%) died in critical care without IMV. Hospital mortality rate was 41.3% for the population. For patients who subsequently commenced IMV, hospital mortality was 58.7% for the standard duration CPAP group and 73.9% for the protracted duration CPAP group (P=0.003); however, there was no statistical difference in hospital mortality after adjustment for confounders (odds ratio 1.4, 95% confidence interval 0.84-2.33, P=0.195).
Protracted CPAP was used frequently for managing patients with COVID-19. Whilst it was not associated with worse outcomes for those patients who subsequently required IMV, this might be due to residual confounding and differences in processes of care.
摘要：
背景：持续气道正压通气（CPAP）已越来越多地用于治疗COVID-19和急性呼吸衰竭的患者，通常是长期的。然而,人们对长期的CPAP表示担忧。这项研究旨在检查CPAP对COVID-19患者的使用情况以及长期使用后的结果。
方法：这是一项全国性的队列研究，研究对象是2020年3月1日至2021年12月25日在苏格兰重症监护病房接受COVID-19治疗并接受CPAP的所有成年人。延长CPAP定义为CPAP连续≥5天。结果包括CPAP失败率（有创机械通气[IMV]或死亡），死亡率,以及建立IMV后的结果。进行了多变量逻辑回归以评估长期CPAP对IMV后死亡率的影响。
结果：共有1961例COVID-19患者接受CPAP治疗COVID-19肺炎，733名患者（37.4%）接受长期CPAP。891例（45.4％）发生CPAP失败：544例（27.7％）接受IMV，347例（17.7％）在没有IMV的重症监护中死亡。该人群的医院死亡率为41.3％。对于随后开始IMV的患者，标准持续时间CPAP组的住院死亡率为58.7%，延长持续时间CPAP组的住院死亡率为73.9%(P=0.003)；校正混杂因素后,住院死亡率无统计学差异(比值比1.4,95%置信区间0.84-2.33,P=0.195).
结论：延长CPAP用于治疗COVID-19患者。虽然对于那些随后需要IMV的患者来说，这与较差的结果无关，这可能是由于残留的混杂因素和护理过程的差异。
方法：这是一项全国性的队列研究，研究对象是2020年3月1日至2021年12月25日在苏格兰重症监护病房接受COVID-19治疗并接受CPAP的所有成年人。延长CPAP定义为CPAP连续≥5天。结果包括CPAP失败率（有创机械通气[IMV]或死亡），死亡率,以及建立IMV后的结果。进行了多变量逻辑回归以评估长期CPAP对IMV后死亡率的影响。
结果：共有1961例COVID-19患者接受CPAP治疗COVID-19肺炎，733名患者（37.4%）接受长期CPAP。891例（45.4％）发生CPAP失败：544例（27.7％）接受IMV，347例（17.7％）在没有IMV的重症监护中死亡。该人群的医院死亡率为41.3％。对于随后开始IMV的患者，标准持续时间CPAP组的住院死亡率为58.7%，延长持续时间CPAP组的住院死亡率为73.9%(P=0.003)；校正混杂因素后,住院死亡率无统计学差异(比值比1.4,95%置信区间0.84-2.33,P=0.195).
结论：延长CPAP用于治疗COVID-19患者。虽然对于那些随后需要IMV的患者来说，这与较差的结果无关，这可能是由于残留的混杂因素和护理过程的差异。
