Infectious Disease

CPAP, high flow nasal oxygen used to treat COVID-19 that is not associated with an increased risk of infection

November 24, 2021

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In a new study, the use of CPAP and high-flow nasal oxygen to treat patients with moderate to severe COVID-19 did not result in higher air or surface virus contamination in the immediate area compared to supplemental oxygen.

“Our results show that the non-invasive breathing support methods do not represent a higher risk of infection, which has a significant impact on the treatment of patients.” Danny McAuley, MD, Professor at Queen’s University Belfast, Northern Ireland, and critical care advisor at Royal Victoria Hospital in Montreal, said in a related press release. “Unless there is a higher risk of transmission of infection, current practice may be too cautious measures for certain situations, for example preventing relatives from visiting the most severe patients, while the risk is underestimated in other situations, such as: B. In cough patients with early infection, generally Guardian. “

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The observational study using environmental samples included 30 patients hospitalized with COVID-19 (mean age 56 years; 13 women) at three centers in the UK from December 2020 to February 2021. All patients had inhaled oxygen levels of 0.4 or more in order to maintain oxygen saturation of 94% or more. The patients received supplemental oxygen (n = 10), CPAP (n = 10), or nasal high-flow oxygen (n = 10). Researchers collected a nasopharynx swab, three air samples, and three surface samples from each participant and the clinical setting.

Twenty-one patients (70%) tested positive for SARS-CoV-2 RNA at the time of assessment by a PCR nasopharyngeal swab. Four (4%) air samples and six (7%) surface samples tested positive for viral RNA. A further 10 samples were suspected to be positive in both air and surface samples.

Using CPAP or high-flow nasal oxygen or coughing in this patient population was not associated with significantly higher viral environmental contamination compared to using supplemental oxygen, according to the researchers.

Out of 51 positive or suspect positive samples, only one sample from the nasopharynx of a patient receiving high-flow nasal oxygen was found to be culture positive.

“This adds to the growing evidence that CPAP and high-flow nasal oxygen for COVID-19 may not be higher-risk procedures associated with their classification as ‘aerosol-generating’. Rather, health worker exposure and nosocomial transmission may be more affected by patient factors such as coughing in earlier stages of infection than by the type of respiratory support used, ”the researchers wrote in Thorax.

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