Intensive Care Medicine

, Volume 40, Issue 7, pp 942–949 | Cite as

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

  • 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



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).


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).


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.


Helmet CPAP reduces the risk of meeting ETI criteria compared to oxygen therapy in patients with severe hARF due to pneumonia.


Continuous positive airway pressure Pneumonia Respiratory failure Intubation 



The authors acknowledge the assistance of Tommaso Maraffi, MD (Emergency Medicine Department, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy). RC takes responsibility for the content of the manuscript, including the data and analysis. Conception and design: RC, AMB, SA, AB, PP; analysis and interpretation: RC, AMB, SA, AB, EP, SN, GF, PP, PT; drafting the manuscript for important intellectual content: RC, AMB, SA, AB, EP, SN, GF, PP, FN, MDF, FC, PT. Funding: Research grant from the IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2014_3325_MOESM1_ESM.doc (694 kb)
Supplementary material 1 (DOC 694 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Anna Maria Brambilla
    • 1
  • Stefano Aliberti
    • 2
  • Elena Prina
    • 1
  • Francesco Nicoli
    • 1
  • Manuela Del Forno
    • 3
  • Stefano Nava
    • 3
  • Giovanni Ferrari
    • 4
  • Francesco Corradi
    • 5
  • Paolo Pelosi
    • 5
  • Angelo Bignamini
    • 6
  • Paolo Tarsia
    • 7
  • Roberto Cosentini
    • 1
  1. 1.Emergency Medicine DepartmentIRCCS Fondazione Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Department of Health ScienceUniversity of Milan BicoccaMonzaItaly
  3. 3.Department of Specialistic, Diagnostic and Experimental Medicine, Respiratory and Critical Care UnitAlma Mater Studiorum, University of Bologna, Sant’Orsola Malpighi HospitalBolognaItaly
  4. 4.High Dependency UnitSan Giovanni Bosco HospitalTurinItaly
  5. 5.IRCCS AOU San Martino IST, Department of Surgical Sciences and Integrated DiagnosticsUniversity of GenoaGenovaItaly
  6. 6.School of Specialization in Hospital PharmacyUniversity of MilanMilanItaly
  7. 7.Department of Pathophysiology and TransplantationUniversity of Milan IRCCS Fondazione Ca’ GrandaMilanItaly

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