Giving hospitalised Covid patients sleep apnoea mask cuts their risk of falling even more ill, a study has suggested.
Researchers at Warwick University and Queen’s University Belfast found continuous positive airway pressure (CPAP) machines stop some seriously ill patients needing to be hooked up to a ventilator.
The therapy — which can cost up to £720 — works by pumping air into the lungs to stop the upper airways from collapsing.
It was originally designed for sleep apnoea sufferers, helping them breathe during the night and stopping them from snoring.
But the NHS says its is helpful in other situations, with the masks used to treat Covid patients since the pandemic began.
The academics sought to compare how CPAP compared to standard oxygen therapy, which delivers oxygen via a loose fitting mask.
The trial of more than 1,200 patient across 48 UK hospitals also looked at HFNO (high pressure oxygen delivered up the nose).
Every one in 12 patients who were moved on from standard oxygen therapy to CPAP were prevented from requiring mechanical ventilation, data suggested.
Researchers said their findings, which have not yet peer-reviewed, can help reduce pressure on intensive care units.
The results should give patients and their families confidence the treatment can be used in place of standard oxygen therapy, the team said.
Giving Covid patients sleep apnoea mask cuts their risk of falling even more ill, a study has suggested. Pictured: A Covid patient is given a continuous positive airway pressure (CPAP) mask as part of her treatment
CAN VENTILATORS CAUSE DAMAGE TO THE LUNGS?
Ventilators pump oxygen under pressure directly into the lungs via a tube inserted down the throat.
Pushing pressurised oxygen into the organs can cause them to become extremely inflamed.
They become irritated which triggers an aggressive immune response, resulting in the inflammation.
Very high levels of oxygen is also harmful because it increases free radical formation, leading to damaged membranes, proteins, and cell structures in the lungs.
Doctors normally circumvent this by making sure to keep pressure levels low and only administer as much oxygen is necessary to keep the organs supplied.
But, in patients who already have severely damaged and inflamed lungs, they can worsen the problem.
Inflammation can cause fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing and getting oxygen to organs increasingly difficult.
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Professor Gavin Perkins, from Warwick, said: ‘By giving patients the most effective treatment to begin with, we can help prevent resource shortages in our NHS and make sure the right type of ventilation is available to patients when it is required.
‘This is the first large trial of different types of ventilation in Covid.
‘While it is encouraging that these results can help reduce the number of people who require invasive ventilation, it is important to stress that, where it is needed, invasive ventilation can be lifesaving.
‘What this trial does, for the first time, is provide an evidence base that can give patients, their families and clinicians, the confidence to step from controlled oxygen therapy to CPAP.
‘One in 12 people [who have] that therapy will escape the need for invasive ventilation.’
Data also suggested the routine use of HFNO should be reconsidered.
Results showed the therapy did not improve outcomes for Covid patients compared, with conventional oxygen therapy.
Professor Perkins said: ‘The routine use of HFNO, which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes.’
The Respiratory Strategies in Covid-19, CPAP, High-flow, and Standard Care (Recovery-RS) trial is the world’s largest non-invasive respiratory support trial for Covid.
All three methods studied are commonly used to treat Covid patients suffering acute respiratory failure.
But it was not known which, if any, resulted in a better outcome.
Between April 2020 and May 2021, 1,272 Covid patients admitted to hospital with acute respiratory failure, aged over the age of 18, were recruited to the study.
They were randomly allocated to receive one of the three respiratory support interventions as part of their hospital care.
CPAP works by pumping air into the lungs to stop the upper airways from collapsing and was designed to help people breathe while they sleep and prevent snoring
WHAT IS A VENTILATOR?
A machine that helps people breathe.
It puts oxygen directly into patients’ lungs and removes carbon dioxide from them.
A breathing tube connects the ventilator machine to your body.
One end of the tube is placed into the lung’s airways through down the throat or nose.
In some serious cases, the tube is connected directly to the windpipe through a small cut in the throat.
Surgery is needed to make the hole in the neck. This is called a tracheostomy.
Patients are heavily sedated so they can’t fight the sensation of being unable to breathe on their own.
Ventilators are used to help a person breathe if they have lung disease or another condition that makes breathing difficult.
They can also be used during and post-surgery.
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The likelihood of patients being hooked up to a ventilator or dying within 30-days of treatment was significantly lower in the CPAP group.
Data showed 137 of 377 participants (36.3 per cent) given CPAP either needed mechanical ventilation or died within 30 days.
For comparison, 158 of 356 participants (44.4 per cent) given standard oxygen treatment saw their condition worsen.
The study, which has been released as a pre-print, found there was no difference between patients in the HFNO and conventional oxygen therapy groups.
Based on these results, one person would avoid needing invasive ventilation within intensive care units (ICU) for every 12 people treated with CPAP instead of standard oxygen therapy, the researchers say.
Professor Danny McAuley, study co-author, said: ‘The results of this trial are really encouraging as they have shown that by using CPAP, invasive ventilation may not be needed for many patients with Covid requiring high oxygen levels.
‘Avoiding invasive ventilation is not only better for the patients, but it also has important resource implications as it frees up ICU capacity.
‘This research should help healthcare professionals in the UK and beyond manage patients with Covid, to improve patient outcomes while helping to lessen the burden on resources.’
Professor Jonathan Van-Tam, deputy chief medical officer, said: ‘This study, funded by the NIHR, provides valuable evidence around how non-invasive respiratory support can be used to improve patient outcomes.
‘Reducing invasive mechanical ventilation is better for patients and reduces pressures on mechanical ventilator capacity across the NHS.’
Source link : https://www.dailymail.co.uk/news/article-9862639/CPAP-reduces-need-invasive-ventilation-Covid-patients-study.html
