Is CPAP a Useful Therapy in Early COVID?
Right around this time two years ago, the debate began on whether or not mechanical ventilators were helping or hurting COVID patients with obvious lung symptoms. Not being a pulmonary specialist, I was still very interested in this debate for two reasons. First, it was critically important to patient health to gain clarity and data on how to correctly manage these cases to decrease mortality. Second, and to be discussed at a later time, this topic was one of the first indications that certain aspects of censorship were beginning to emerge throughout various health systems in the USA and around the world.
The only contribution I attempted to make was the likelihood that many of the more severely ill patients could be suffering from undiagnosed and untreated sleep apnea. As so many of the patients had past histories of obesity and hypertension, these two common findings strongly suggest the presence of sleep-disordered breathing. For these reasons, I recommended attention be given to the use of CPAP or other PAP devices in the treatment of early COVID cases, and if you want more on this topic, please read my three-part series on Sleep & The Pandemic on the right-hand side of the home page.
Fast forward and we see more and more research is looking into the role of CPAP with particular emphasis on whether or not it might prevent the need for a mechanical ventilator. In this current study, three groups of “newish” COVID cases were compared, based on early use of CPAP, High Flow Oxygen, or conventional nasal cannula oxygen. Several hundred people were studied in each group, and although the actual effects were not particularly large, CPAP proved the best agent for preventing mechanical ventilation compared to the standard group using conventional oxygen. High flow oxygen was no better than standard oxygen.
The study design does not yield definitive guidelines, but I find it encouraging this sort of research is now being conducted (better late than never). Going forward, what I’m hearing in a few clinical circles is that some facilities are regularly using CPAP devices in the early treatment of COVID and that’s a step in the right direction.