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

Abstract

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

ARDS: challenges in patient care and frontiers in research

“…While noninvasive mechanical ventilatory support by face mask was found to affect neither intubation rates nor clinical outcomes in a randomised controlled trial (RCT) of 123 ARDS patients [5], helmet ventilation was found to reduce the need for intubation when compared to oxygen therapy in a multicentre RCT of 81 ARDS patients [6], and to reduce intubation rates and even to improve survival when compared to a face mask in a single-centre randomised clinical trial of 83 ARDS patients [7]. Oxygen administered through a high-flow nasal cannula is suggested to be an attractive strategy as a first-line therapy to avoid intubation, seen in the results of a multicentre RCT in which 301 hypoxaemic patients without hypercapnia received either high-flow oxygen therapy, standard oxygen therapy delivered through a face mask or noninvasive positive-pressure ventilation [8], but the beneficial effects found thus far need to be confirmed.…”

Helmet CPAP Versus Oxygen Therapy in Hypoxemic Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials

“…3 and 4. In patients treated Brambilla, et al 8 Cosentini, et al 9 Squadrone, et al 11 Squadrone, et al (Fig. 4), compared to patients receiving standard oxygen therapy.…”

“…Of these, 304 studies were excluded for the following reasons: 145 duplicate studies; 45 case reports and abstracts; 97 studies without examination of hARF; 15 non-RCTs; one incomplete hARF study carried out by Fasano, et al; 16 and one study by Antonaglia, et al 17 using facial NIV in the control group. Four clinical [8][9][10][11] trials comprising 377 subjects met the inclusion criteria (Table 1). All trials were RCTs, and three of these, were multicenter studies, [9][10][11] and one 9 was a single center study.…”

“…Cosentini, et al 9 Squadrone, et al 11 Brambilla, et al 8 Squadrone, et al Helmet CPAP vs. Oxygen Therapy in hARF: A Meta-Analysis…”

“…In Europe, oral-nasal masks are the most commonly used interface for NIV; 7 however, the helmet interface has gained wide acceptance in some countries, such as Italy, as a more comfortable interface for patients with hARF. 7 Several studies have evaluated the efficacy of helmet CPAP for hARF, [8][9][10][11][12] and most have found that helmet CPAP significantly reduced the intubation rate and mortality while improving clinical outcomes compared to standard oxygen therapy. However, a robust conclusion has not been reached on the utility of helmet CPAP owing to the small sample size in current RCTs.…”