The role of CPAP and HFNC in COVID-19

Depending on the severity of COVID-19-induced respiratory disease, different treatment modalities can be applied regarding the use of continuously delivered continuous positive airway pressure (cCPAP) and high flow nasal cannula therapy (HFNC).

By using cCPAP, an airflow is delivered to the airways by establishing a positive pressure which is maintained through the respiratory cycle. HFNC consists of warm, humified oxygen which is being delivered in a high flow by a nasal cannula. In patients with mild to moderate COVID-19, the target is acceptable SpO₂ obtainable with ≤5 L O₂/min (FiO₂ 0.4) oxygen therapy delivered by bi-nasal canula or air-entrainment mask. For patients with severe COVID-19, the target is acceptable SpO₂ obtainable with 6-15 L O₂/min (FiO₂ 0.4–0.6), and the ICU personnel should be advised about the patient’s condition. cCPAP is not contraindicated, whereas intermittent mandatory ventilation (IMV) is not indicated. The initial flow of HFNC is 45 L/min and additional oxygen may be administered to meet the target SpO₂. In the case of critical COVID-19, the target is acceptable SpO₂ obtainable with ≥15 L O₂/min (FiO₂ >0.6); depending on the contraindications to IMV, patients may be intubated, or CPAP and HFNC can be continued at higher flow/higher FiO₂ at intermediate or intensive care unit. Furthermore, bilevel (Bi)PAP at 10/20 cm H₂0 may be used, with the effect evaluated after 2 hours [1].

1. Bertelsen BB. CPAP and HFNC for COVID-19 and hypoxemic respiratory failure. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

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