Helmet CPAP versus Oxygen Therapy in Hypoxemic Acute Respiratory Failure: A Meta-Analysis of Randomized Controlled Trials

다국어 초록 (Multilingual Abstract)

Purpose: The efficacy of helmet continuous positive airway pressure (CPAP) in hypoxemic acute respiratory failure (hARF) remainsunclear. 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.
Materials and Methods: We performed a meta-analysis of randomized controlled trials (RCTs) 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), intubationrate [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).
Conclusion: The results of this meta-analysis suggest that helmet CPAP improves oxygenation and reduces mortality and intubationrates in hARF. However, the significant clinical and statistical heterogeneity of the literature implies that large RCTs are neededto determine the role of helmet CPAP in different hypoxemic ARF populations.

참고문헌 (Reference)

1 Brett A, "Use of continuous positive airway pressure in the management of community acquired pneumonia" 48 : 1280-1281, 1993

2 Delclaux C, "Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial" 284 : 2352-2360, 2000

3 Pang D, "The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: a systematic review" 114 : 1185-1192, 1998

4 Higgins JP, "The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials" 343 : d5928-, 2011

5 Lau J, "Quantitative synthesis in systematic reviews" 127 : 820-826, 1997

6 L’Her E, "Physiologic effects of noninvasive ventilation during acute lung injury" 172 : 1112-1118, 2005

7 Mas A, "Noninvasive ventilation in acute respiratory failure" 9 : 837-852, 2014

8 Hillberg RE, "Noninvasive ventilation" 337 : 1746-1752, 1997

9 Mehta S, "Noninvasive ventilation" 163 : 540-577, 2001

10 Antonelli M, "Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study" 100 : 16-24, 2004

11 Keenan SP, "Noninvasive positive pressure ventilation in acute respiratory failure" 284 : 2376-2378, 2000

12 Chiumello D, "Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask" 29 : 1671-1679, 2003

13 Tonnelier JM, "Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study" 29 : 2077-2080, 2003

14 Principi T, "Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure" 30 : 147-150, 2004

15 Nava S, "Non-invasive ventilation in acute respiratory failure" 374 : 250-259, 2009

16 Nava S, "Non-invasive pressure support ventilation in acute hypoxemic respiratory failure: common strategy for different pathologies?" 28 : 1205-1207, 2002

17 Higgins JP, "Measuring inconsistency in meta-analyses" 327 : 557-560, 2003

18 Nava S, "Interfaces and humidification for noninvasive mechanical ventilation" 54 : 71-84, 2009

19 Cammarota G, "Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure" 37 : 1095-1102, 2011

20 Cosentini R, "Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial" 138 : 114-120, 2010

21 Brambilla AM, "Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia" 40 : 942-949, 2014

22 Patroniti N, "Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study" 29 : 1680-1687, 2003

23 Fasano L, "Efficacy of helmet as interface for noninvasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF)" 142 (142): 946A-, 2012

24 Squadrone V, "Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy" 36 : 1666-1674, 2010

25 Squadrone V, "Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial" 293 : 589-595, 2005

26 Lindner KH, "Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions" 92 : 66-70, 1987

27 Antonaglia V, "Comparison of noninvasive ventilation by sequential use of mask and helmet versus mask in acute exacerbation of chronic obstructive pulmonary disease: a preliminary study" 82 : 148-154, 2011

28 Esquinas Rodriguez AM, "Clinical review: helmet and non-invasive mechanical ventilation in critically ill patients" 17 : 223-, 2013

29 Chiumello D, "A systematic technical review of the systems for the continuous positive airway pressure" 78 : 1385-1393, 2012

30 Crimi C, "A European survey of noninvasive ventilation practices" 36 : 362-369, 2010