Continuous Positive Airway Pressure (CPAP) for Moderate to Severe Covid19 Acute Respiratory Distress Syndrome (CARDS) in a Resource limited setting

TLDR: In this article, the survival outcomes and characteristics of a cohort of patients with moderate to severe acute respiratory distress syndrome (CARDS) were treated exclusively with CPAP in a rural secondary level hospital in Pakistan with limited previous critical care expertise.

Abstract: Introduction Covid19 Acute Respiratory Distress Syndrome (CARDS) poses a challenge in management particularly due to limited capacity of ventilated intensive care beds and staffing, and this is exacerbated in resource poor settings with poor patient outcomes. Within this context CPAP has been trialled for CARDS although mainly in resource rich settings. Methods This study retrospectively analyses the survival outcomes and characteristics of a cohort of patients with moderate to severe CARDS were treated exclusively with CPAP in a rural secondary level hospital in Pakistan with limited previous critical care expertise. Results 32 out of the 41 patients (78%) who were treated with CPAP survived overall (30/37 (81%) who were treated according to protocol). Discussion Results suggest non inferiority to CARDS outcomes of critical care units employing Intubation and Mechanical Ventilation (IMV) in resource rich settings. CPAP should be promoted as an efficacious and cost-effective method for treating CARDS within the context of the pandemic surge of Covid19 in resource poor settings. Key Messages What is the key question? Is Continuous Positive Airway Pressure (CPAP) an effective treatment for Covid19 Acute Respiratory Distress Syndrome (CARDS) in a resource poor setting in a pandemic surge context? What is the bottom line? Survival rate for CARDS on CPAP in our single centre retrospective cohort study is 78% which is similar to outcomes from critical care centres in resource rich settings employing Intubation and Mechanical Ventilation (IMV) and better than outcomes in many critical care centres in resource poor settings. This suggests CPAP should be promoted as an efficacious and cost-effective method for managing the pandemic surge of CARDS in resource poor settings. Why read on? The current surge of Covid19 CARDS in resource poor settings poses a significant challenge in terms of effective management given cost and resource restraints, reflected by poor outcomes in overwhelmed critical care centres employing IMV. This is the largest study so far documenting the survival outcomes and characteristics of patients with CARDS treated exclusively with CPAP within a resource poor setting.