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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
Affiliation:1. Emergency Medicine Department, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
2. Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy
3. Department of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care Unit, Alma Mater Studiorum, University of Bologna, Sant’Orsola Malpighi Hospital, Bologna, Italy
4. High Dependency Unit, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, 10154, Turin, Italy
5. IRCCS AOU San Martino IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
6. School of Specialization in Hospital Pharmacy, University of Milan, Via Colombo, 71, Milan, Italy
7. Department of Pathophysiology and Transplantation, University of Milan IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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.
Keywords:
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