{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T23:30:06Z","timestamp":1756683006617,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2021,11,2]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Respiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, \u03c7<jats:sup>2<\/jats:sup>=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, \u03c7<jats:sup>2<\/jats:sup>=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Our single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjresp-2021-001044","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T12:01:51Z","timestamp":1638273711000},"page":"e001044","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8942-5424","authenticated-orcid":false,"given":"Chris D","family":"Turnbull","sequence":"first","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford NIHR Biomedical Research Centre, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedict M L","family":"Porter","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah B","family":"Evans","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Smith","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Lardner","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hallifax","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford NIHR Biomedical Research Centre, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry V","family":"Bettinson","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas P","family":"Talbot","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford NIHR Biomedical Research Centre, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9993-2478","authenticated-orcid":false,"given":"Mona","family":"Bafadhel","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford NIHR Biomedical Research Centre, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najib M","family":"Rahman","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford NIHR Biomedical Research Centre, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nayia","family":"Petousi","sequence":"additional","affiliation":[{"name":"Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"},{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Oxford NIHR Biomedical Research Centre, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"2025083110211856000_8.1.e001044.1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02130-2020","article-title":"Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia","volume":"56","author":"Franco","year":"2020","journal-title":"Eur Respir 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Connolly BA . An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19. medRxiv.doi:10.1101\/2021.08.02.21261379","DOI":"10.1101\/2021.08.02.21261379"},{"key":"2025083110211856000_8.1.e001044.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n579"},{"key":"2025083110211856000_8.1.e001044.8","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1016\/S1473-3099(21)00318-2","article-title":"Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: an observational cohort study","volume":"21","author":"Patone","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2025083110211856000_8.1.e001044.9","doi-asserted-by":"crossref","DOI":"10.1183\/23120541.00541-2020","article-title":"Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit","volume":"7","author":"Vaschetto","year":"2021","journal-title":"ERJ Open Res"},{"key":"2025083110211856000_8.1.e001044.10","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2466-14-19","article-title":"Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies","volume":"14","author":"Ozyilmaz","year":"2014","journal-title":"BMC Pulm Med"},{"key":"2025083110211856000_8.1.e001044.11","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04220"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2021-001044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:21:28Z","timestamp":1756660888000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2021-001044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,11,30]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1136\/bmjresp-2021-001044"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2021-001044","relation":{},"ISSN":["2052-4439"],"issn-type":[{"type":"electronic","value":"2052-4439"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}