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)(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. © 2010 American College of Chest Physicians.