Comparison of non-invasive ventilation on bilevel pressure mode and CPAP in the treatment of COVID-19 related acute respiratory failure. A propensity score-matched analysis.

Objective: The purpose of this study was to analyze the differences in the effectiveness and complications of CPAP versus non-invasive ventilation on bilevel positive airway pressure (BiPAP) in the treatment of COVID-19 associated acute respiratory failure (ARF).

Design: Retrospective observational study.

Setting: ICU.

Patients: All COVID-19 patients, admitted to an ICU between March 2020 and February 2023, who required CPAP or BiPAP were analyzed.

Interventions: Use of CPAP or BiPAP in COVID-19 associated ARF.

Main variables of interest: Initial clinical variables, CPAP and BiPAP failure rate, complications, in-hospital mortality.

Results: 429 patients were analyzed, of whom 328 (76.5%) initially received CPAP and 101 (23.5%) BiPAP. Initial respiratory rate was 30 ± 8 in the CPAP group and 34 ± 9 in BiPAP (p < 0.001), while PaO₂/FiO₂ was 120 ± 26 and 111 ± 24 mmHg (p = 0.001), respectively. The most frequent complication related to the device was claustrophobia/discomfort, 23.2% in CPAP and 25.7% in BiPAP (p = 0.596), while the most frequent complications not related to the device were severe ARDS, 58.6% and 70.1% (p = 0.044), and hyperglycemia, 44.5% and 37.6%, respectively (p = 0.221). After adjusting by propensity score matched analysis, neither failure of the device (OR 1.37, CI 95% 0.72-2.62) nor in-hospital mortality (OR 1.57, CI 95% 0.73-3.42) differed between both groups.

Conclusions: Either non-invasive ventilatory device failure or mortality rate differed in patients initially treated with CPAP versus BiPAP.