Helmet CPAP versus oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized controlled trial.
Chest. 2010 Feb 12;
Authors: Cosentini R, Brambilla AM, Aliberti S, Bignamini A, Nava S, Maffei A, Martinotti R, Tarsia P, Monzani V, Pelosi P
Aim: To evaluate the efficacy of non-invasive CPAP delivered by helmet in improving oxygenation in comparison to oxygen therapy in community-acquired pneumonia (CAP). METHODS: a multicentre, randomized, controlled trial enrolling CAP patients admitted to an Emergency Department with moderate hypoxemic acute respiratory failure (ARF) (PaO(2)/FiO(2) ratio >/=210 and </=285). Patients were randomized to helmet CPAP or standard oxygen therapy (control group). The primary endpoint was the time to reach a PaO(2)/FiO(2) ratio >315. After reaching this value, patients randomized to CPAP were switched to oxygen and the proportion of subjects who could maintain a PaO(2)/FiO(2) ratio >315 at 1 hour was recorded. RESULTS: Forty-seven patients were recruited: 20 randomized to CPAP and 27 to controls. Patients randomized to CPAP reached the endpoint in a median of 1.5 hour, while controls in 48 hours, (p<0.001). The proportion of patients who reached the primary endpoint was 95% (19/20) among CPAP group, and 30% (8/27) among controls (p<0.001). One hour after reaching the primary endpoint, 2/14 patients in CPAP group maintained a PaO(2)/FiO(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 utility of CPAP in CAP patients.
PMID: 20154071 [PubMed - as supplied by publisher]