COVID-19 trial finds continuous positive airway pressure (CPAP) reduces need for invasive ventilation in hospitalised patients

A landmark UK trial – which compared three commonly used respiratory interventions to establish which works best for COVID-19 patients with acute respiratory failure – has reported ‘encouraging’ results.

The RECOVERY-RS trial has demonstrated that treating hospitalised COVID-19 patients who have acute respiratory failure with Continuous Positive Airway Pressure (CPAP), reduces the need for invasive mechanical ventilation.

Preliminary data from the trial also suggests that the routine use of High Flow Nasal Oxygenation (HFNO), which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes for COVID-19 patients, compared with conventional oxygen therapy.

Led by the University of Warwick and Queen’s University Belfast, RECOVERY-RS is the world’s largest non-invasive respiratory support trial for COVID-19 – with more than 1,200 participants taking part across 48 UK hospitals.

At North Manchester General Hospital – which formally joined Manchester University NHS Foundation Trust in April 2021 – 17 patients took part in the study.

The multi-centre, adaptive, randomised controlled trial compared the use of CPAP (oxygen and positive pressure delivered via a tightly fitting mask), with HFNO (high pressure oxygen delivered up the nose), against standard care (standard oxygen therapy).

All three interventions are commonly used to treat COVID-19 patients before they are moved onto invasive ventilation in a critical care bed, but it was not known which, if any, resulted in better outcomes. 

Professor Gavin Perkins, Chief Investigator and Professor in Critical Care Medicine at Warwick Medical School at the University of Warwick said: “The RECOVERY-RS trial showed that CPAP was effective at reducing the need for invasive ventilation, thus reducing pressures on critical care beds. 

“The routine use of high flow nasal oxygenation, which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes. 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-19. 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.”

Professor Jonathan Van-Tam, Deputy Chief Medical Officer said: “COVID-19 has placed huge pressure on our hospitals and intensive care units, and our doctors, nurses and all NHS staff have stepped up to meet that challenge. A key part of tackling COVID has been the improvements that staff have identified and then implemented in terms of how to best care for COVID patients.

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.

“I want to thank the team of doctors, researchers and patient volunteers involved in today’s excellent results – hospitals across the country can now use these data to further improve care for patients and reduce the demand for mechanical ventilation as we get closer to what might still be a challenging winter period.”

Dr Nita Sehgal, Consultant Respiratory Physician and Principal Investigator of RECOVERY-RS at North Manchester General Hospital, said: “I would like to thank every North Manchester General Hospital patient who has taken part in this trial, and in all of our COVID-19 studies, as without volunteers, we simply could not carry out this vital research.

These new results from the RECOVERY-RS study demonstrate that we are finding out more about this virus and how to treat it all the time – underlining the continued importance of research.

Professor Jane Eddleston, MFT Group Joint Medical Director and Consultant in Intensive Care Medicine and Anaesthesia, said: “The RECOVERY-RS trial has shown the effectiveness of CPAP in reducing the need for invasive ventilation in patients with respiratory failure secondary to COVID-19.

This is the first large trial of different types of ventilation in critically ill patients with COVID-19 and whilst encouraging that these results demonstrate a reduction in the need for invasive ventilation, it is important to stress that where indicated invasive ventilation can be life-saving.

Read more about RECOVERY-RS and its results via this news story on the NIHR website.