Continuous positive airway pressure in COVID-19-associated respiratory failure: improving patient care with a proforma

As a respiratory nurse specialist the author has an active role in the assessment and management of patients who develop COVID-19-associated respiratory failure requiring continuous positive airway pressure (CPAP) therapy. CPAP is a form of non-invasive positive airway pressure, widely recognised as an essential therapeutic modality for the management of COVID-19-associated respiratory failure. It reduces in-hospital mortality, avoids the need for invasive mechanical ventilation and reduces length of stay in hospital. To date, there is no definitive strategy within national or regional UK guidelines on CPAP initiation and up-titration pressure settings or duration of therapy for COVID-19-associated respiratory failure, leading the author to develop and implement a CPAP protocol proforma in his area of practice.

In a measure to improve patient safety, and ensure correct documentation and implementation of CPAP therapy, the implementation of a CPAP proforma has provided a standardised protocol approach to the initiation, duration and cessation of CPAP therapy for hospitalised patients with COVID-19-associated respiratory failure. In hospital settings where there has been a high rotation of medical and nursing staff, including staff working unsociable hours and working outside of their areas of expertise (as happened during the height of the pandemic), the use of a proforma clearly defining protocol can contribute to safe and high-quality care and help ensure CPAP therapy is provided with continuity and efficacy.