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Chest. 2010 Jul;138(1):114-20. doi: 10.1378/chest.09-2290. Epub 2010 Feb 12.

Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial.

Author information

1
Emergency Medicine Department, Gruppo NIV, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy. roberto.cosentini@policlinico.mi.it

Abstract

OBJECTIVE:

Our objective was to evaluate the efficacy of noninvasive continuous positive airway pressure (CPAP) delivered by helmet in improving oxygenation in comparison with oxygen therapy in community-acquired pneumonia (CAP).

METHODS:

This was a multicenter, randomized, controlled trial enrolling patients with CAP admitted to an ED with moderate hypoxemic acute respiratory failure (ARF) (Pa(O(2))/Fi(O(2)) ratio > or = 210 and < or = 285). Patients were randomized to helmet CPAP or standard oxygen therapy (control group). The primary end point was the time to reach a Pa(O(2))/Fi(O(2)) ratio > 315. After reaching this value, patients randomized to CPAP were switched to oxygen, and the proportion of subjects who could maintain a Pa(O(2))/Fi(O(2)) ratio > 315 at 1 h was recorded.

RESULTS:

Forty-seven patients were recruited: 20 randomized to CPAP and 27 to controls. Patients randomized to CPAP reached the end point in a median of 1.5 h, whereas controls reached the end point in 48 h (P < .001). The proportion of patients who reached the primary end point was 95% (19/20) among the CPAP group and 30% (8/27) among controls (P < .001). One hour after reaching the primary end point, 2/14 patients in the CPAP group maintained a Pa(O(2))/Fi(O(2)) value > 315.

CONCLUSIONS:

CPAP delivered by helmet rapidly improves oxygenation in patients with CAP suffering from a moderate hypoxemic ARF. This trial represents a proof-of-concept evaluation of the potential usefulness of CPAP in patients with CAP.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00603564.

PMID:
20154071
DOI:
10.1378/chest.09-2290
[Indexed for MEDLINE]

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