The UK National Institute for Health Research (NIHR)-supported RECOVERY-RS trial has shown that continuous positive airway pressure (CPAP) reduces the invasive mechanical ventilation requirements in hospitalised Covid-19 patients.

The multi-centre, adaptive, randomised controlled trial enrolled a total of 1,272 adult patients admitted with acute respiratory failure at 48 hospitals in the UK.

Led by the University of Warwick and Queen’s University Belfast, this trial is the largest non-invasive respiratory support study for Covid-19, NIHR noted.

The participants were randomised to receive CPAP, high-flow nasal oxygenation (HFNO) or standard care of conventional oxygen treatment.

CPAP treatment delivers oxygen and positive pressure through a tightly fitting mask.

As the primary outcomes, the trial analysed if the subjects needed invasive mechanical ventilation via tracheal intubation or did not survive within 30 days of commencing the treatment.

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Data showed that subjects treated with CPAP were less likely to need invasive ventilation or die within 30 days of therapy as against traditional oxygen treatment.

Furthermore, 36.3% of subjects in the CPAP arm either required mechanical ventilation or died within 30 days versus 44.4% in the standard care arm.

No difference in primary outcomes was seen in the HFNO-treated patients when compared to those on standard oxygen therapy.

Nearly 44.4% of patients in the HFNO arm required mechanical ventilation or died as against 45.1% in the traditional oxygen treatment arm.

The initial trial results indicate that the routine use of HFNO, which uses higher amounts of oxygen, should be reassessed as it failed to boost outcomes in Covid-19 patients as against conventional oxygen treatment, NIHR added.

These data also demonstrate that for every 12 people receiving CPAP instead of standard care, one would not need invasive ventilation in intensive care units.

Trial chief investigator and Warwick Medical School critical care medicine professor Gavin Perkins said: “The RECOVERY-RS trial showed that CPAP was effective at reducing the need for invasive ventilation, thus reducing pressures on critical care beds.

“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.”