Due to the challenges to safely deliver invasive ventilation, there is a need for other treatment options. Invasive ventilation (e.g. mechanical ventilators) can cause pressure-related tissue injury in the lung. A good alternative may be the non-invasive respiratory support to treat COVID-19 related breathing problems, but also other respiratory health issues, such as COPD (Chronic obstructive pulmonary disease).

Working together with clinicians from Blackpool Teaching Hospital, our team, called RaCES (Rapid Conversion of Evidence Summaries), looked at three scientific journal articles. These articles reviewed the evidence around the use of non-invasive respiratory support (ventilation mask) in the management of COVID-19, as well as mortality and clinical outcomes in patients who received this type of treatment. We summarised the evidence and judged its quality. While we still need more research to explore the potential of non-invasive ventilation in the treatment of COVID-19, this option may provide a suitable prevention method to avoid the use of mechanical ventilators.

Hospital data shows some sobering reality around rates of withdrawal from the use of CPAP (/ci: pap/), as clinicians call it, which is Continuous Positive Airway Pressure, a form of non-invasive ventilation. In 23 cases out of the 42 we looked at, the withdrawal was patient-initiated, which is a surprisingly high number considering that the lives of these patients depended on its use. This is why we got together with the clinicians to design a leaflet that supports patients to use and keep on the ventilation mask even when it is uncomfortable. In the design, we took advantage of the useful invention of behaviour science, what we call behaviour change techniques. For instance, the leaflet provides information about the pros and cons of using the mask, or encouraging the use of the mask through quotes from patients and carers around their experiences and views.

To evaluate the impact of the leaflet, we are comparing an existing Blackpool Teaching Hospital dataset to new data we are collecting once the leaflet is in circulation. We will be collecting the same data for six months on non-invasive ventilation failure, including mortality and escalation to invasive mechanical ventilation. We hope the findings will facilitate an increase in the uptake of non-invasive ventilation and a reduction in mortality and poor clinical outcomes.

Watch out for an update regarding our findings!

Authors:
Roger Kenyon
ARC NWC Public Adviser

Dr Oliver Hamer, PhD, PGCTHE, FHEA.
Synthesis, Economic Evaluation and Decision Science (SEEDS) Group
ARC NWC IMPlementation and Capacity building Team (IMPaCT)

Dr Katalin Ujhelyi Gomez (She/Her)
Postdoctoral Research Associate
Primary Care and Mental Health & ARC NWC MIDAS
University of Liverpool