• Natalie Webber, Malcolm Avari, Georgina Harridge, Jane Neerkin, Emily Collis, and Ronan Astin.
• University College London Hospitals NHS Foundation Trust, London, UK nataliewebber@nhs.net.
• Clin Med (Lond). 2021 Jul 1; 21 (4): e392e394e392-e394.

BackgroundNo published protocol to guide the withdrawal of continuous positive airway pressure (CPAP) for patients with COVID-19 exists.Case SeriesDescription 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.Outcome19 patients died on the high-dependency respiratory unit following treatment with CPAP. 89% died with CPAP withdrawn.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.DiscussionThe 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.© Royal College of Physicians 2021. All rights reserved.

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