Critical Care: Critical Care: Mechanical Ventilation |

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

Yu-wen Luo; Yan Luo; Yun Li; Lu-qian Zhou; Zhe Zhu; Xin Chen, MD
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Southern Medical University, Guangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A164. doi:10.1016/j.chest.2016.02.170
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SESSION TITLE: Critical Care: Mechanical Ventilation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: The efficacy of helmet continuous positive airway pressure (CPAP) in hypoxemic acute respiratory failure (hARF) remains unclear. The aim of this meta-analysis was to critically review studies that investigated the effect of helmet CPAP on gas exchange, mortality, and intubation rate in comparison with standard oxygen therapy.

METHODS: We performed a meta-analysis of randomized controlled trials by searching the PubMed, Embase, Cochrane library, OVID, and CBM databases, and the bibliographies of the retrieved articles. Studies that enrolled adults with hARF who were treated with helmet CPAP and measured at least one of the following parameters were included: gas exchange, intubation rate, in-hospital mortality rate.

RESULTS: Four studies with 377 subjects met the inclusion criteria and were analyzed. Compared to the standard oxygen therapy, helmet CPAP significantly increased the PaO2/FiO2 (weighted mean difference [WMD] = 73.40, 95% confidence interval[95% CI]: 43.92 to 102.87, p<0.00001) and decreased the arterial carbon dioxide levels (WMD = -1.92. 95% CI: -3.21 to -0.63, p = 0.003), intubation rate (relative risk [RR] = 0.21, 95% CI: 0.11 to 0.40, p < 0.00001), and in-hospital mortality rate (RR = 0.22, 95% CI: 0.09 to 0.50, p = 0.0004).

CONCLUSIONS: The results of this meta-analysis suggest that helmet CPAP improves oxygenation and reduces the mortality and intubation rates significantly. A large RCT is needed to determine the role of helmet CPAP in ARF. Helmet CPAP is an effective treatment for hypoxemic acute respiratory failure.

CLINICAL IMPLICATIONS: The present meta-analysis may add to the currently lacking data comparing helmet CPAP and oxygen therapy in hypoxemic acute respiratory failure.

DISCLOSURE: The following authors have nothing to disclose: Yu-wen Luo, Yan Luo, Yun Li, Lu-qian Zhou, Zhe Zhu, Xin Chen

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