Can CPAP Therapy be used in COVID-19 intervention? |

Can CPAP Therapy be used in COVID-19 intervention? |

COVID-19 Treatment and Management

In the past year, our understanding of COVID-19 and how to deal with it has constantly been morphing based on findings from empirical studies and clinical observations. Due to how it has pushed healthcare systems worldwide to their limits, clinicians and researchers have been working on overdrive to look for solutions to help optimize COVID-19 treatment and management.

According to the Centers for Disease Control and Prevention (CDC), the Food and Drugs Administration has approved medications such as remdesivir to aid with COVID-19 treatment. Dexamethasone, a steroid medication, is also recommended for COVID-19 patients who are in need of supplemental oxygen. Emergency Use Authorizations (EUA) have also been issued by the FDA for banlanvimab and casirivimab plus imdevimab. Doctors also try to help boost the body’s immune system by recommending infusion of convalescent plasma taken from donors who have previously contracted the virus.

It is important to note that these medications should only be administered as prescribed by a physician. Moreover, these are not recommended to be used by healthy individuals.

Aside from the mentioned medications, doctors also recommend the following more accessible treatments:

  • Taking over-the-counter medications such as ibuprofen and acetaminophen to help manage fever.
  • Staying hydrated by drinking water often or having oral water intake supplemented the administration of fluids intravenously.
  • Getting a lot of sleep and rest to help the body fight off the virus.

As mentioned, the scale of the COVID-19 pandemic has led to many hospitals worldwide being overwhelmed by a sudden influx of patients with varying degrees of related symptoms. Due to this influx, many hospitals have struggled with the amount of occupied ventilators and ICU beds that were being taken up by COVID-19 patients. Given this, experts found it extremely necessary to search for early intervention treatments to help prevent the need for a ventilator or speed up the recovery process.

A recent retrospective case-control study was conducted using data gathered from acute inpatient units in three UK hospitals: Wrightington, Wigan, and Leigh Teaching Hospitals which are all medium-sized institutions that exist under the NHS Trust. In this study, researchers focused on determining the impact of CPAP therapy on COVID-19 treatment.

What is CPAP Therapy?

Continuous Positive Airway Pressure (CPAP) Therapy is often prescribed to patients that suffer from sleep apnea. This form of therapy uses machines to apply a mild air pressure to keep the airways open and prevent any breathing problems from occurring during sleep. Given this, CPAP Therapy is a helpful aid in promoting good-quality sleep by ensuring breathing is kept steady and uninterrupted throughout the night.

middle aged man wearing CPAP mask

CPAP Therapy is also recommended for patients who snore and are fatigued during their waking hours. It also may be suggested for patients who have respiratory disorders, hypertension, muscle disorders, hypothyroidism, chronic obstructive pulmonary disease, and obesity, among other conditions.

As mentioned, CPAP Therapy involves the use of machines and a variety of accessories like tubing, masks, cushions, and supplies to help with the upkeep of the device. These machines may be calibrated to create just enough pressure to meet the patient’s specific needs. The patient may consult with a pulmonologist or sleep therapist to figure out which calibration, machine, and mask would work best for them. Prior to proceeding with the treatment, the patient may be subjected to a sleep study to allow their doctor or therapist to collect data on their breathing patterns and general behavior during sleep.

CPAP Therapy for COVID-19 Treatment

The study conducted by Ashish et. al. surveyed a total of 206 patients that tested positive for COVID-19. All of the surveyed patients were also admitted due to related severe acute respiratory syndrome early on, right in the onslaught of the pandemic. The outcomes that were measured were the time between being tested positive for COVID-19 to either discharge or death.

All 206 patient participants were hospitalized for COVID-19 between March 17 and May 18, 2020. Some of these participants were selected by their doctors to receive CPAP therapy via Resmed Airsense devices and oxygen was set to be delivered at the standard rate of 10-15 liters per minute or an estimate of 50%-70% of inhaled oxygen. CPAP Treatment was administered due to protocols that were set during the time of admission.

The first or ‘early group’ is considered to be the ‘control group’ of the study, of which only 3 patients were given CPAP Treatment. Between April 3 and April 10, changes were implemented to support the early use of CPAP in managing moderate to severe COVID-19 cases. The second group of participants were selected from the patient population admitted during the time the early use of CPAP Therapy was implemented. The ‘late group’ participants were roughly matched with the participants in the first group to meet similar age ranges and notable preexisting conditions (i.e. diabetes, obesity, respiratory problems,  hypertension, renal issues, etc.)  in an effort to control the variables and ensure any differences between the two groups may be attributed to the implementation or non-implementation of the early use of CPAP Therapy in COVID-19 management. 

Why Incorporate CPAP Therapy in COVID-19 Treatment?

During the ‘early group’ period, CPAP Therapy was regarded as a rescue treatment given to patients to prevent the development of the need for intubation in an ICU. However, later on, clinical data-based development steered clinicians towards recommending CPAP Therapy earlier on in a COVID-19 patient’s treatment plan due to how this non-invasive ventilator can help prevent lung injury and reduce tissue stress, vascular flow, and fluid leakage.

Research Results for CPAP Therapy in COVID-19 Treatment

It was noted that more severe cases were admitted during the late group period due to the significant increase in deaths, lower survival time, and longer discharge time. There was also a significant increase in the number of patients that had been residing in care homes upon being admitted. It was found that CPAP patients in the late group had significantly better outcomes compared to those who did not receive CPAP treatment during this time. Mortality was reduced and a higher percentage of patients were able to recover without the need for mechanical ventilation in the CPAP late group.

It is important to understand that although this study is a hopeful beginning in the quest to determine whether or not CPAP Therapy can be incorporated into COVID-19 Treatment plans on a wider scale, the data the study generated is not nearly enough to make a definitive statement. There is much to be done to expand on its sampling and ensuring all variables are accounted for and controlled.