Objective: Our objective was to evaluate the efficacy of noninvasive continuous positive airway pressure(CPAP) delivered by helmet in improving oxygenation in comparison with oxygen therapy in community-acquired pneumonia(CAP). Methods: This was a multicenter, randomized, controlled trial enrolling patients with CAP admitted to an ED with moderate hypoxemic acute respiratory failure(ARF)(PaO2/FIO2 ratio ≥ 210 and ≤285). Patients were randomized to helmet CPAP or standard oxygen therapy(control group). The primary end point was the time to reach a PaO 2 /FIO2 ratio >315. After reaching this value, patients randomized to CPAP were switched to oxygen, and the proportion of subjects who could maintain a PaO2/FIO2 ratio >315 at 1 h was recorded. Results: Forty-seven patients were recruited: 20 randomized to CPAP and 27 to controls. Patients randomized to CPAP reached the end point in a median of 1.5 h, whereas controls reached the end point in 48 h(P<.001). The proportion of patients who reached the primary end point was 95%(19/20) among the CPAP group and 30%(8/27) among controls(P<.001). One hour after reaching the primary end point, 2/14 patients in the CPAP group maintained a PaO 2 /FIO2 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 usefulness of CPAP in patients with CAP. Trial registration: clinicaltrials.gov; Identifier: NCT00603564.
Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia : a randomized, controlled trial / R. Cosentini, A.M. Brambilla, S. Aliberti, A. Bignamini, S. Nava, A. Maffei, R. Martinotti, P. Tarsia, V. Monzani, P. Pelosi. - In: CHEST. - ISSN 0012-3692. - 138:1(2010), pp. 114-120.
|Titolo:||Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia : a randomized, controlled trial|
|Settore Scientifico Disciplinare:||Settore MED/10 - Malattie dell'Apparato Respiratorio|
|Data di pubblicazione:||2010|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1378/chest.09-2290|
|Appare nelle tipologie:||01 - Articolo su periodico|