Helmet Continuous Positive Airway Pressure vs Oxygen Therapy To Improve Oxygenation in Community-Acquired Pneumonia A Randomized, Controlled Trial

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) (Pa(2) /FIO(2) 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)/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 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)/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 usefulness of CPAP in patients with CAR Trial registration: clinicaltrials.gov; Identifier: NCT00603564. CHEST 2010; 138(1):114-120