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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2014

01-07-2014 | Original

Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia

Authors: Anna Maria Brambilla, Stefano Aliberti, Elena Prina, Francesco Nicoli, Manuela Del Forno, Stefano Nava, Giovanni Ferrari, Francesco Corradi, Paolo Pelosi, Angelo Bignamini, Paolo Tarsia, Roberto Cosentini

Published in: Intensive Care Medicine | Issue 7/2014

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Abstract

Purpose

The efficacy of noninvasive continuous positive airway pressure (CPAP) to improve outcomes in severe hypoxemic acute respiratory failure (hARF) due to pneumonia has not been clearly established. The aim of this study was to compare CPAP vs. oxygen therapy to reduce the risk of meeting criteria for endotracheal intubation (ETI).

Methods

In a multicenter randomized controlled trial conducted in four Italian centers patients with severe hARF due to pneumonia were randomized to receive helmet CPAP (CPAP group) or oxygen delivered with a Venturi mask (control group). The primary endpoint was the percentage of patients meeting criteria for ETI, including either one or more major criteria (respiratory arrest, respiratory pauses with unconsciousness, severe hemodynamic instability, intolerance) or at least two minor criteria (reduction of at least 30 % of basal PaO2/FiO2 ratio, increase of 20 % of PaCO2, worsening of alertness, respiratory distress, SpO2 less than 90 %, exhaustion).

Results

Between February 2010 and 2013, 40 patients were randomized to CPAP and 41 to Venturi mask. The proportion of patients meeting ETI criteria in the CPAP group was significantly lower compared to those in the control group (6/40 = 15 % vs. 26/41 = 63 %, respectively, p < 0.001; relative risk 0.24, 95 % CI 0.11–0.51; number needed to treat, 2) two patients were intubated in the CPAP group and one in the control group. The CPAP group showed a faster and greater improvement in oxygenation in comparison to controls (p < 0.001). In either study group, no relevant adverse events were detected.

Conclusions

Helmet CPAP reduces the risk of meeting ETI criteria compared to oxygen therapy in patients with severe hARF due to pneumonia.
Appendix
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Metadata
Title
Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia
Authors
Anna Maria Brambilla
Stefano Aliberti
Elena Prina
Francesco Nicoli
Manuela Del Forno
Stefano Nava
Giovanni Ferrari
Francesco Corradi
Paolo Pelosi
Angelo Bignamini
Paolo Tarsia
Roberto Cosentini
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 7/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-014-3325-5

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