Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia
Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia
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DOI：
10.1007/s00134-014-3325-5
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发表时间：
2014-07-01
影响因子：
38.9
通讯作者：
Cosentini, Roberto
中科院分区：
文献类型：
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作者：
Brambilla, Anna Maria;Aliberti, Stefano;Cosentini, Roberto
无创持续气道正压通气（CPAP）改善肺炎所致严重低氧血症急性呼吸衰竭（hARF）结局的有效性尚未明确确定。本研究的目的是比较CPAP与氧气治疗，以降低符合气管插管（ETI）标准的风险。在意大利四个中心进行的多中心随机对照试验中，因肺炎导致严重hARF的患者随机接受头盔CPAP（CPAP组）或使用文丘里面罩（对照组）输送氧气。主要终点是符合ETI标准的患者百分比，包括一个或多个主要标准（呼吸骤停、呼吸暂停伴意识丧失、严重血流动力学不稳定、不耐受）或至少两项次要标准（基础PaO 2/FiO（2）比值降低至少30%，PaCO 2升高20%，警觉性恶化，呼吸窘迫，2010年2月至2013年2月，40名患者随机接受CPAP治疗，41名患者随机接受Venturi面罩治疗。CPAP组符合ETI标准的患者比例明显低于对照组（6/40 = 15% vs. 26/41 = 63%，p < 0.001;相对危险度0.24，95%CI 0.11-0.51; 2）CPAP组2例插管，对照组1例插管。与对照组相比，CPAP组显示出更快和更大的氧合改善（p < 0.001）。与氧疗相比，头盔式CPAP可降低因肺炎导致的重度hARF患者达到ETI标准的风险。
The efficacy of noninvasive continuous positive airway pressure (CPAP) to improve outcomes in severe hypoxemic acute respiratory failure (hARF) due to pneumonia has not been clearly established. The aim of this study was to compare CPAP vs. oxygen therapy to reduce the risk of meeting criteria for endotracheal intubation (ETI).In a multicenter randomized controlled trial conducted in four Italian centers patients with severe hARF due to pneumonia were randomized to receive helmet CPAP (CPAP group) or oxygen delivered with a Venturi mask (control group). The primary endpoint was the percentage of patients meeting criteria for ETI, including either one or more major criteria (respiratory arrest, respiratory pauses with unconsciousness, severe hemodynamic instability, intolerance) or at least two minor criteria (reduction of at least 30 % of basal PaO2/FiO(2) ratio, increase of 20 % of PaCO2, worsening of alertness, respiratory distress, SpO(2) less than 90 %, exhaustion).Between February 2010 and 2013, 40 patients were randomized to CPAP and 41 to Venturi mask. The proportion of patients meeting ETI criteria in the CPAP group was significantly lower compared to those in the control group (6/40 = 15 % vs. 26/41 = 63 %, respectively, p < 0.001; relative risk 0.24, 95 % CI 0.11-0.51; number needed to treat, 2) two patients were intubated in the CPAP group and one in the control group. The CPAP group showed a faster and greater improvement in oxygenation in comparison to controls (p < 0.001). In either study group, no relevant adverse events were detected.Helmet CPAP reduces the risk of meeting ETI criteria compared to oxygen therapy in patients with severe hARF due to pneumonia.