Supporting Winter Pressures: The Role of CPAP and HFOT on the Wards
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Supporting Winter Pressures: The Role of CPAP and HFOT on the Wards
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According to the UK Parliament’s report, hospitals faced a “quad-demic” of respiratory viruses, with almost 600,000 hospital beds occupied by patients with COVID-19, flu, RSV or norovirus between November 2024 and March 2025. Flu-related bed days alone rose to 315,000, nearly double the previous winter [1].
Lord Darzi’s Independent Investigation of the NHS (September 2024) noted that long-term reductions in bed capacity have left many hospitals in a perpetual bed crisis. Despite 2,000 additional general and acute beds being open compared to 2022/23, bed occupancy routinely exceeded 100% in some hospitals—well above the safe 85% threshold recommended by the Royal College of Emergency Medicine [2].
The NHS’s 2025/26 Urgent and Emergency Care Plan now focuses on improving patient flow, expanding out-of-hospital care, and reducing the need for critical care admissions.
In this context, ward-based respiratory support, including CPAP and HFOT, offers a practical and proactive solution [3].
What Is CPAP and HFOT?
Continuous Positive Airway Pressure (CPAP) delivers a constant level of air pressure throughout the breathing cycle to keep airways open, improve oxygenation and respiratory effort [4]. CPAP is non-invasive therapy, delivered via interfaces such as a face mask, hood or tracheostomy while patients are awake and spontaneously breathing.
Alongside CPAP, High Flow Oxygen Therapy (HFOT) delivers heated, humidified oxygen at high flow rates to improve oxygenation and comfort while reducing the work of breathing.
Traditionally, CPAP and HFOT have been reserved for intensive care or high-dependency settings. However, advances in technology, training, and monitoring now make it possible to safely and effectively deliver these therapies on respiratory wards — particularly for patients with mild to moderate acute respiratory failure (ARF).
Who Benefits from Ward-Based CPAP and HFOT?
Ward-based CPAP and HFOT can support a range of patients, including:
- Patients with mild ARF who are at risk of deterioration [5]
- Those with COPD exacerbations — CPAP helps splint the airways open, improving ventilation and reducing the work of breathing.
- Patients with pneumonia or COVID-related hypoxia — HFOT can maintain oxygenation and comfort while avoiding escalation to invasive ventilation [4].
- Individuals requiring humidified oxygen support who do not yet need ICU-level intervention.
By stabilising respiratory function early, these therapies can reduce escalation to critical care, shorten hospital stays, and improve outcomes, all crucial goals during peak winter demand.
The NAVIGATE Trial: Evidence for Early NIV on the Wards
The NAVIGATE trial, an international multicentre randomised controlled trial published in 2024, explored the role of early non-invasive ventilation (NIV) in general wards for patients with mild ARF [6].
Key findings include:
- A 35% reduction in progression to severe respiratory distress or low oxygen levels.
- 89.8% of participants received CPAP without additional pressure support.
- Only 1 in 5 patients receiving early NIV developed serious breathing issues, compared to 1 in 3 under usual care.
- No increase in complications or serious side effects.
The NAVIGATE trial confirmed that CPAP is safe, well-tolerated, and effective even outside ICU settings. This finding is particularly significant for NHS hospitals seeking to manage respiratory patients safely within ward environments during periods of high demand.
By reinforcing the principle of early intervention, the NAVIGATE data supports the NHS’s goal of delivering more advanced care closer to home — and reducing avoidable ICU admissions.
Technology Enabling Safer Ward-Based Support: The AquaVENT® FD140i
Devices such as the AquaVENT® FD140i have been developed to meet this evolving clinical need. The AquaVENT® FD140i enables clinicians to deliver both CPAP and HFOT using a single system and circuit, allowing seamless transitions between therapies without the need to change equipment.
This flexibility supports:
- Therapy breaks without interrupting respiratory support.
- Improved patient comfort and compliance through heated and humidified gases.
- Better pressure area care, allowing rotation between interfaces for CPAP and HFOT.
- Reduced clinical workload and consumable waste through quick, simple therapy transitions.
- 60-minute battery back-up, facilitating safe interhospital transfers.
With integrated alarms and robust monitoring, the AquaVENT® FD140i gives clinicians the confidence to deliver advanced respiratory therapies safely outside critical care.
Why Early Intervention Matters
Early identification and management of respiratory deterioration are key to maintaining patient safety, especially during winter. By equipping respiratory wards with CPAP and HFOT capability, hospitals can stabilise patients before they reach crisis, improving both patient outcomes and patient flow.
This approach not only supports the NHS’s Urgent and Emergency Care Plan objectives but also aligns with the wider shift toward proactive, ward-based interventions that preserve critical care capacity.
Conclusion: A Proactive Step for Winter Resilience
As hospitals prepare for another challenging winter, early use of ward-based CPAP and HFOT represents a proactive, evidence-based solution to help alleviate pressure on critical care.
The NAVIGATE trial reinforces what many respiratory clinicians already observe — the earlier we intervene, the better the outcomes. With the right technology, training, and clinical protocols, general wards can safely deliver high-quality respiratory care, keeping patients stable, supported, and closer to home.
Abby Lennon
Clinical Nurse Adviser, RN
Abby works alongside the Clinical Education Team to provide support and education to healthcare professionals using her knowledge and experience as a registered nurse working in respiratory wards and intensive care units over the last eight years.
References
[1] Powell T, Strain D. NHS winter preparedness: Commons Library Research Briefing (CBP-10320). House of Commons Library; 15 August 2025. Available from: https://researchbriefings.files.parliament.uk/documents/CBP-10320/CBP-10320.pdf
[2] Darzi L. Independent Investigation of the National Health Service in England (updated 25 September 2024). London: HM Government; 2024. Available from: https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf
[3] NHS England. Urgent and emergency care plan 2025/26. Published 6 June 2025; last updated 19 September 2025. Available from: https://www.england.nhs.uk/long-read/urgent-and-emergency-care-plan-2025-26/
[4] Rosà, T., Menga, L.S., Tejpal, A., Cesarano, M., Michi, T., Sklar, M.C. and Grieco, D.L. (2022). Non-invasive ventilation for acute hypoxemic respiratory failure, including COVID-19. Journal of Intensive Medicine. [online] doi:https://doi.org/10.1016/j.jointm.2022.08.006.
[5] Munshi L, Mancebo J, Brochard LJ. Noninvasive Respiratory Support for Adults with Acute Respiratory Failure. N Engl J Med. 2022 Nov 3;387(18):1688-1698. doi: 10.1056/NEJMra2204556. PMID: 36322846.
[6] Monti G, Cabrini L, Kotani Y, Brusasco C, Kadralinova A, Giardina G, et al. Early noninvasive ventilation in general wards for acute respiratory failure: an international, multicentre, open-label, randomised trial. Br J Anaesth. 2025 Feb;134(2):382-391. doi:10.1016/j.bja.2024.11.023
