Is CPAP therapy in COVID-19 associated with an increased rate of pulmonary barotrauma?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 150 million people worldwide, with over 3 million deaths as of 6thth May 2021 [1]. In the United Kingdom (UK) approximately 15% of individuals affected by coronavirus disease 2019 (COVID-19) have required admission to hospital [2] and those with severe disease require advanced respiratory support including invasive mechanical ventilation (IMV) [3]. Due to the considerable scale of the pandemic, non-invasive continuous positive airway pressure (CPAP) has been utilised for COVID-19-related type I respiratory failure as a therapeutic strategy to improve patient outcomes [4, 5] and also to preserve IMV capacity during a challenging time for acute healthcare providers. Its exact role is however unclear and is the subject of a UK multicentre trial [6]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Jones has nothing to disclose. Conflict of interest: Dr. Nightingale reports grants from Medical Research Council (MRC), outside the submitted work;. Conflict of interest: Dr. Burhan reports grants from Astra Zeneca Grant: Respiratory High Risk Asthhma Clinic Proposal - 2019-055, personal fees from Novartis Advisory Board Attendance Fee, personal fees from Astra Zeneca Speaking Fees, personal fees from Chiesi Speaking Fees, personal fees from GSK Speaking Fees, other from Travel, Accomodation and Attendance Fees for European Respiratory Society Meeting, Paris, 2018, from Health Foundation Innovating for Improvement Round 6 Grant: Improving Heroin Smokers' access to COPD Community Services, outside the submitted work;. Conflict of interest: Outside of this work has previously received honorarium from GSK, AstraZeneca, Chiesi and Pfizer and non-financial support from Napp. All other authors have no declarations. Conflict of interest: Dr. BARBER has nothing to disclose. Conflict of interest: Dr. Bond has nothing to disclose. Conflict of interest: Dr. Parker has nothing to disclose. Conflict of interest: Dr. Duffy has nothing to disclose. Conflict of interest: Dr. Hampshire has nothing to disclose. Conflict of interest: Dr. Gautam has nothing to disclose.