Helmet CPAP Vs. Oxygen Therapy in Severe Hypoxemic Respiratory Failure Due to Pneumonia

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2014 May 13

PMID 24817030

Citations 71

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

Affiliations

Soon will be listed here.

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.

Citing Articles

Preoxygenation strategies before intubation in patients with acute hypoxic respiratory failure: a network meta-analysis.

Ye N, Wei C, Deng J, Wang Y, Xie H Front Med (Lausanne). 2025; 12:1532911.

PMID: 39995692 PMC: 11847861. DOI: 10.3389/fmed.2025.1532911.

Comparison of the effectiveness of the helmet interface using flow meters versus the mechanical ventilator for non-invasive ventilation in patients with coronavirus disease 2019. Controlled and randomized clinical trial.

Dos Reis Ferreira F, Correa J, Storopoli E, Faria D, Cassaro K, Feitosa da Hora N Arch Med Sci. 2024; 20(5):1538-1546.

PMID: 39649277 PMC: 11623150. DOI: 10.5114/aoms/183947.

Oxygen therapy and noninvasive respiratory supports in acute hypoxemic respiratory failure: a narrative review.

Thille A, Balen F, Carteaux G, Chouihed T, Frat J, Girault C Ann Intensive Care. 2024; 14(1):158.

PMID: 39419924 PMC: 11486880. DOI: 10.1186/s13613-024-01389-w.

Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference.

Helms J, Catoire P, Abensur Vuillaume L, Bannelier H, Douillet D, Dupuis C Ann Intensive Care. 2024; 14(1):140.

PMID: 39235690 PMC: 11377397. DOI: 10.1186/s13613-024-01367-2.

The "ZEEP-PEEP test" to evaluate the response to positive end-expiratory pressure delivered by helmet: A prospective physiologic study.

Giani M, Fumagalli B, Cipulli F, Rezoagli E, Pozzi M, Fumagalli D Heliyon. 2024; 10(6):e28339.

PMID: 38524568 PMC: 10957420. DOI: 10.1016/j.heliyon.2024.e28339.

References

Delclaux C, LHer E, Alberti C, Mancebo J, Abroug F, Conti G . Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. JAMA. 2000; 284(18):2352-60. DOI: 10.1001/jama.284.18.2352. View

Squadrone V, Coha M, Cerutti E, Schellino M, Biolino P, Occella P . Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005; 293(5):589-95. DOI: 10.1001/jama.293.5.589. View

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View

Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A . Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003; 168(12):1438-44. DOI: 10.1164/rccm.200301-072OC. View

Corrado A, Roussos C, Ambrosino N, Confalonieri M, Cuvelier A, Elliott M . Respiratory intermediate care units: a European survey. Eur Respir J. 2002; 20(5):1343-50. DOI: 10.1183/09031936.02.00058202. View

Lim W, Baudouin S, George R, Hill A, Jamieson C, Le Jeune I . BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009; 64 Suppl 3:iii1-55. DOI: 10.1136/thx.2009.121434. View

Confalonieri M, Potena A, Carbone G, Porta R, Tolley E, Meduri G . Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med. 1999; 160(5 Pt 1):1585-91. DOI: 10.1164/ajrccm.160.5.9903015. View

10.

Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S . Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med. 2000; 28(6):1785-90. DOI: 10.1097/00003246-200006000-00015. View

11.

Cosentini R, Brambilla A, Aliberti S, Bignamini A, Nava S, Maffei A . Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial. Chest. 2010; 138(1):114-20. DOI: 10.1378/chest.09-2290. View

12.

Ramirez J, Srinath L, Ahkee S, Huang A, Raff M . Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia. Arch Intern Med. 1995; 155(12):1273-6. View

13.

Sanz F, Restrepo M, Fernandez E, Mortensen E, Aguar M, Cervera A . Hypoxemia adds to the CURB-65 pneumonia severity score in hospitalized patients with mild pneumonia. Respir Care. 2011; 56(5):612-8. DOI: 10.4187/respcare.00853. View

14.

Jaber S, Michelet P, Chanques G . Role of non-invasive ventilation (NIV) in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010; 24(2):253-65. DOI: 10.1016/j.bpa.2010.02.007. View

15.

Principi T, Pantanetti S, Catani F, Elisei D, Gabbanelli V, Pelaia P . Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med. 2003; 30(1):147-50. DOI: 10.1007/s00134-003-2056-9. View

16.

Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M . Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect. 2011; 17 Suppl 6:E1-59. PMC: 7128977. DOI: 10.1111/j.1469-0691.2011.03672.x. View

17.

Mariani J, Macchia A, Belziti C, Deabreu M, Gagliardi J, Doval H . Noninvasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials. J Card Fail. 2011; 17(10):850-9. DOI: 10.1016/j.cardfail.2011.05.010. View

18.

Keenan S, Sinuff T, Burns K, Muscedere J, Kutsogiannis J, Mehta S . Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011; 183(3):E195-214. PMC: 3042478. DOI: 10.1503/cmaj.100071. View

19.

Dellinger R, Levy M, Rhodes A, Annane D, Gerlach H, Opal S . Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013; 39(2):165-228. PMC: 7095153. DOI: 10.1007/s00134-012-2769-8. View

20.

Plant P, Owen J, Elliott M . Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000; 355(9219):1931-5. DOI: 10.1016/s0140-6736(00)02323-0. View