Implementing a novel protocol for withdrawal of CPAP support in COVID-19 patients: a case series

Natalie Webber, Malcolm Avari, Georgina Harridge, Jane Neerkin, Emily Collis, Ronan Astin
Clinical Medicine: Journal of the Royal College of Physicians of London 2021 May 6

BACKGROUND: No published protocol to guide the withdrawal of continuous positive airway pressure (CPAP) for patients with COVID-19 exists.

CASE SERIES: Description of the introduction of a novel protocol, developed by consensus to guide the withdrawal of CPAP for patients diagnosed as dying with COVID-19 in an acute hospital.

OUTCOME: 19 patients died on the high-dependency respiratory unit following treatment with CPAP. 89% died with CPAP withdrawn. The dying trajectory was difficult to predict. Symptoms were managed promptly and effectively with a combination of opioids, benzodiazepines and close medical supervision. No concerns were raised by families regarding the decision making or withdrawal process.

DISCUSSION: The use of the protocol ensures a comfortable and dignified death and supports the delivery of individualised care at the end of life. Future research on this topic should focus on qualitative outcomes and consider the applicability of this protocol in other patient groups.

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