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Background COVID-19 is associated with significant mortality and morbidity in high risk groups requiring ventilatory support as per the Intensive Care National Audit & Research Centre (ICNARC) 1 Mechanical (IMV) and non-mechanical ventilation modalities [Continuous positive airway pressure (CPAP)/High Flow Nasal Oxygen (HFNO)] support acute respiratory failure in COVID-19 but the mortality data comparing these modalities is limited Gloucestershire NHS Foundation Trust admitted a total of 860 COVID-19 patients, 130 requiring ventilatory support between February-July 2020;the highest number in the South-West Respiratory High dependency (HDU) and Intensive care units (ITU) were reconfigured in anticipation of clinical demand with HDU expanded to 31 beds compared to a normal capacity of 10 and ITU expanded to 36 beds, compared to a usual capacity of 12 Patients requiring CPAP only were managed on HDU unless deemed at high risk of deterioration to require IMV Method We conducted a prospective observational study to assess comparative mortality in all COVID-19 patients admitted to HDU/ITU with acute respiratory failure and treated with IMV versus CPAP/HFNO or both Parameters assessed included age, gender, clinical frailty score (CFS), co-morbidities, smoking and resuscitation status Comparative mortality was assessed statistically by calculating relative risk ratio and p-value using Welch's t-test Results 130 patients were treated with CPAP/HFNO, IMV or both Overall mortality was 33% (n=43) Resuscitation status and treatment escalation plans were reviewed for all patients on admission 1 5% patients (n=2) had a pre-existing DNAR and CPR was not deemed appropriate for 23% patients (n=30) 62% patients (n=58) required IMV out of 72% patients (n=93) deemed suitable for it Comparative mortality between all 3 subgroups is summarised in table 1 Discussion Overall mortality was higher among COVID-19 patients requiring IMV reflecting disease severity Male gender, previous smoking history, airways disease, hypertension, diabetes, CKD and immunosuppression were associated with higher mortality in patients requiring IMV Interestingly CFS of >3 was associated with increased mortality in the CPAP cohort compared to CFS of |
