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