Helmet CPAP versus Oxygen Therapy in Hypoxemic Acute Respiratory Failure: A Meta-Analysis of Randomized Controlled Trials.
10.3349/ymj.2016.57.4.936
- Author:
Yuwen LUO
1
;
Yan LUO
;
Yun LI
;
Luqian ZHOU
;
Zhe ZHU
;
Yitai CHEN
;
Yuxia HUANG
;
Xin CHEN
Author Information
1. Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China. chen_xin1020@163.com
- Publication Type:Comparative Study ; Meta-Analysis ; Original Article ; Review
- Keywords:
Helmets;
continuous positive airway pressure;
respiratory failure;
meta-analysis;
endotracheal intubation;
mortality
- MeSH:
Acute Disease;
Adult;
*Continuous Positive Airway Pressure;
Hospital Mortality;
Humans;
*Oxygen Inhalation Therapy;
Randomized Controlled Trials as Topic;
Respiratory Insufficiency/mortality/*therapy
- From:Yonsei Medical Journal
2016;57(4):936-941
- CountryRepublic of Korea
- Language:English
-
Abstract:
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. 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), 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). CONCLUSION: The results of this meta-analysis suggest that helmet CPAP improves oxygenation and reduces mortality and intubation rates in hARF. However, the significant clinical and statistical heterogeneity of the literature implies that large RCTs are needed to determine the role of helmet CPAP in different hypoxemic ARF populations.
