CompletedInterventional

RECOVERY Respiratory Support: Respiratory Strategies in patients with coronavirus COVID-19 – CPAP, high-flow nasal oxygen, and standard care

When COVID-19 affects the lungs, breathing can become very difficult, and patients often need extra oxygen in hospital. In severe cases, people may need a mechanical ventilator—a machine that breathes for them through a tube in their windpipe. This UK clinical trial looks at whether other breathing supports can prevent patients from needing a ventilator. Hospitalised adults with COVID-19 were randomly assigned to one of three treatments: CPAP (a snug mask that gently pushes air into the lungs), high-flow nasal oxygen (warm oxygen blown quickly through small nose tubes), or standard oxygen through a regular mask. All three methods are already routinely used in the NHS. The research team tracked patients over 30 days to see which method was best at helping people recover, shortening hospital stays, and keeping people off mechanical ventilators.

At a glance

Status

Completed

Sponsor

University of Warwick

Enrolment target

4,002

Start

06 Apr 2020

Estimated completion

03 May 2021

Respiratory failure in patients with known or suspected COVID-19 (SARS-CoV-2 infection)

What is this study about?

COVID-19 can cause severe lung inflammation, making it difficult for the body to get enough oxygen. When standard oxygen masks are not enough, doctors traditionally turn to mechanical ventilators in intensive care. Ventilators save lives, but being placed on one requires strong sedation and carries a longer, tougher recovery. During the pandemic, finding ways to help patients breathe comfortably without needing a ventilator became an urgent priority.

This study, called RECOVERY-RS, compares three breathing treatments to find out which works best. The first is Continuous Positive Airway Pressure (CPAP), which delivers air and oxygen under gentle pressure through a tightly fitting face mask to keep airways open. The second is high-flow nasal oxygen, which delivers warm, humidified oxygen at high speed through soft prongs in the nostrils. The third is standard oxygen therapy using a normal face mask.

Both CPAP and high-flow nasal oxygen are already well-known, trusted treatments across NHS hospitals for other chest conditions. By comparing them directly against standard oxygen, researchers wanted to learn which treatment gives patients with COVID-19 the best chance of recovering without having to go onto a breathing machine in intensive care.

The trial was led by the University of Warwick and supported by the National Institute for Health and Care Research (NIHR). Its findings help NHS doctors choose the most effective, gentle breathing support as soon as someone begins to struggle with oxygen levels.

Key takeaways

The trial compared CPAP masks, high-flow nasal oxygen, and standard oxygen masks for hospitalised COVID-19 patients.
All treatments tested were already standard, proven NHS breathing therapies.
The primary goal was to prevent patients from needing an invasive mechanical ventilator.
Care was delivered on hospital wards, with health outcomes tracked for 30 days.
Taking part did not require any extra hospital visits after discharge.

Who may be eligible?

This trial was designed for adults aged 18 and older who were admitted to hospital with confirmed or suspected COVID-19. To be considered, patients needed extra oxygen because their blood oxygen levels were falling below safe levels despite receiving standard oxygen therapy.

Participants also had to be patients who were suitable for intensive care and a ventilator if their condition worsened. This meant the medical team was ready to step up treatment if necessary.

People could not join if they needed an emergency breathing tube within the hour, were pregnant, or had medical reasons why a tight mask could not be worn. It was also not suitable for patients whose care was focused purely on comfort and end-of-life support, or if the hospital did not have the required equipment available.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

Aged 18 or older
Admitted to an NHS hospital with suspected or confirmed COVID-19
Needing higher levels of oxygen to keep blood oxygen stable
Fit and suitable to receive intensive care if breathing worsened
Not pregnant
Not needing an immediate emergency breathing tube within the hour

Answer every question to see your result.

What does participation involve?

Because breathing problems can worsen quickly, treatment began immediately upon joining the trial. Patients were assigned to one of the three breathing treatments by a computer system, giving them an equal chance of receiving CPAP, high-flow nasal oxygen, or a standard oxygen mask. In urgent situations where someone was too unwell or confused to give consent straight away, treatment was started first and consent was discussed as soon as the patient or their family was able.

Care took place entirely within the hospital ward or high-dependency unit. Doctors and nurses monitored oxygen levels, breathing comfort, and general health as part of regular hospital care. There were no extra tests or appointments outside of normal care. Researchers recorded how patients got on over a 30-day period, noting whether they needed a ventilator, how long they stayed in hospital, and their overall recovery.

Potential risks and benefits

Participants had the potential benefit of receiving an active breathing treatment that might prevent the need for an invasive ventilator and speed up recovery. However, both CPAP and high-flow nasal oxygen can cause mild side effects. These include a dry mouth or nose, a feeling of mild sickness, and soreness or red marks on the face from the tight straps of the mask. Taking part was entirely voluntary. Patients or their representatives had the right to step down from the study at any point, and doing so never altered the quality of NHS care they received.

Locations (76)

Warwick Clinical Trials Unit
City only
Coventry, England
Aintree Hospital
Approximate
Liverpool, England
Altnagelvin Hospital
Approximate
Londonderry, Northern Ireland
Barnet Hospital
Approximate
Barnet, England
Bedford Hospital
Approximate
Bedford, England
Belfast City Hospital
Unverified
Belfast, Northern Ireland
Castle Hill Hospital
Unverified
Cottingham, England
Charing Cross Hospital (Lead Centre)
Unverified
London, England
Colchester General Hospital
Unverified
Colchester, England
Conquest Hospital, Hastings
Unverified
St. Leonards-On-Sea, England
Croydon University Hospital
Unverified
Croydon, England
Derriford Hospital
Unverified
Plymouth, England

Common questions

What is the difference between CPAP and an invasive ventilator?

CPAP supports your natural breathing using a soft mask over your face, and you remain awake. An invasive ventilator takes over your breathing completely through a tube placed down the windpipe, which requires heavy sedation in intensive care.

Are CPAP and high-flow nasal oxygen experimental treatments?

No. Both treatments are used every day in NHS hospitals for other lung conditions, such as sleep apnoea or chronic lung diseases. The trial simply looked at which one works best specifically for COVID-19.

Why was consent sometimes taken after starting the treatment?

Low oxygen levels can cause confusion, and delaying breathing support can be dangerous. To protect patient safety, treatment was started straight away, and full consent was gathered as soon as the patient was well enough or their family could be contacted.

Did patients have to stay in hospital longer to take part?

No. Patients stayed only as long as their medical condition required. Once ready to go home, they were discharged as normal, and researchers simply checked hospital records up to day 30.

Can members of the public sign up for this trial now?

No. This study recruited patients who were already unwell in hospital beds during the peak of the pandemic and is no longer accepting public volunteers.

How to find out more

Keith Couper

k.couper@warwick.ac.uk 442476151179 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.