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Original Research: COMMUNITY-ACQUIRED PNEUMONIA |

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

Roberto Cosentini, MD; Anna Maria Brambilla, MD; Stefano Aliberti, MD; Angelo Bignamini, PhD; Stefano Nava, MD; Antonino Maffei, MD; Renato Martinotti, MD; Paolo Tarsia, MD; Valter Monzani, MD; Paolo Pelosi, MD
Author and Funding Information

From the Emergency Medicine Department (Drs Cosentini, Brambilla, and Monzani), Gruppo NIV, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; the Thoracopulmonar and Cardiovascular Department (Drs Aliberti and Tarsia), University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; the School of Specialization in Hospital Pharmacy (Dr Bignamini), University of Milan, Milan; the Respiratory Intensive Care Unit (Dr Nava), Fondazione S. Maugeri, Istituto Scientifico di Pavia, IRCCS, Pavia; the Emergency Medicine Unit (Dr Maffei), Ospedale San Paolo, Naples; the Emergency Medicine Department (Dr Martinotti), Ospedale San Carlo, Milan; and the Department of Ambient, Health and Safety (Dr Pelosi), University of Insubria, Varese, Italy.

Correspondence to: Roberto Cosentini, MD, Emergency Medicine Department, Gruppo NIV, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; e-mail: roberto.cosentini@policlinico.mi.it


This work was presented as an oral communication at Società Italiana di Medicina d’Emergenza-Urgenza (SIMEU), VI Annual Congress, Rimini, Italy, November 5, 2008.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):114-120. doi:10.1378/chest.09-2290
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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 Pao2/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 Pao2/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

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