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

Intensive Care Medicine volume 40, pages 942–949 (2014)Cite this article

An Erratum to this article was published on 27 May 2014

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Emergency Medicine Department, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Anna Maria Brambilla, Elena Prina, Francesco Nicoli & Roberto Cosentini

  2. Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy

    Stefano Aliberti

  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

    Manuela Del Forno & Stefano Nava

  4. High Dependency Unit, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, 10154, Turin, Italy

    Giovanni Ferrari

  5. IRCCS AOU San Martino IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy

    Francesco Corradi & Paolo Pelosi

  6. School of Specialization in Hospital Pharmacy, University of Milan, Via Colombo, 71, Milan, Italy

    Angelo Bignamini

  7. Department of Pathophysiology and Transplantation, University of Milan IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Paolo Tarsia

Authors
  1. Anna Maria Brambilla
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  2. Stefano Aliberti
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  3. Elena Prina
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  4. Francesco Nicoli
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  5. Manuela Del Forno
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  6. Stefano Nava
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  7. Giovanni Ferrari
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  8. Francesco Corradi
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  9. Paolo Pelosi
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  10. Angelo Bignamini
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  11. Paolo Tarsia
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  12. Roberto Cosentini
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Corresponding author

Correspondence to Roberto Cosentini.

Additional information

Take-home message: Our results show a reduction of the risk of meeting criteria for intubation with helmet CPAP in comparison to oxygen therapy in severe hARF due to pneumonia. Helmet CPAP also promotes a faster and greater improvement in oxygenation, with no relevant adverse events during treatment.

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Brambilla, A.M., Aliberti, S., Prina, E. et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med 40, 942–949 (2014). https://doi.org/10.1007/s00134-014-3325-5

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