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

11 May 2023
Volume 32 · Issue 9


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes (COVID-19) has proven to be the greatest challenge to modern global health care, infecting more than 450 million people worldwide and responsible for just over 6 million deaths. Over the past 2 years there have been major advances in the treatment of COVID-19, including a significant reduction in the number of individuals developing severe symptoms, since the introduction of COVID-19 vaccines and the advances in pharmacological treatments. However, for those individuals who become infected with COVID-19 and develop acute respiratory failure, the use of continuous positive airway pressure (CPAP) continues to be an essential management strategy that reduces mortality risk and the need for invasive mechanical ventilation. Without any standard regional or national guidelines on CPAP initiation and up-titration during the pandemic, a protocol proforma was devised for use in the author's clinical area. This was particularly useful for staff caring for seriously ill COVID-19 patients who were unfamiliar with providing CPAP. It is hoped that this article will contribute to the knowledge base of nurses and may encourage them to create a similar proforma for use in their clinical area.

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.

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