Investigating Some Effective Factors on the Prediction of Continuous Positive Airway Pressure Failure Rate in COVID-19-Related Hypoxemia.

Background: Considering the importance of using Non-Invasive Ventilation (NIV) in COVID-19-related hypoxemia, the present study was conducted to determine the effective factors on Continuous Positive Airway Pressure (CPAP) failure rate in COVID-19-related hypoxemia.

Materials and methods: This research was a retrospective cross-sectional study (2021) investigating the records of 200 adult patients with the medical diagnosis of acute respiratory failure (ARF) of COVID-19, admitted to the Intensive Care Unit (ICU) in Shoushtar (southwestern Iran) who underwent CPAP therapy. The Heart rate, Acidosis, Consciousness, Oxygenation, and Respiratory rate (HACOR) scores were measured before the treatment and 1 h after undergoing CPAP treatment. Moreover, patients' demographic and clinical data were recorded. Data were analyzed using the Mann-Whitney, Chi-square, Wilcoxon, and logistic regression tests. The significance level was set at p ≤ 0.05.

Results: The mean standard deviation [SD]) age of patients was 63.96 (16.23) years. Among all 200 patients, 78.50% (n = 157) experienced CPAP failure and the remaining 21.50% (n = 43) underwent successful CPAP therapy. Failure chance was 7.10% higher in patients with higher HACOR scores undergoing 1 h CPAP treatment than others. It was also 14.92% higher among patients with diabetes mellitus (DM) than non-DM patients. Additionally, old age (z = 2591.50, p value = 0.02), obesity (z = 2433.00, p value = 0.024), and elevated Blood Urea Nitrogen (BUN) (z = 2620.00, p value = 0.0) impacted CPAP failure rates among patients.

Conclusions: The HACOR score 1 h after CPAP, DM, old age, obesity, and elevated BUN favor increased CPAP failure rates among patients.