Yonsei Med J.  2016 Jul;57(4):936-941. 10.3349/ymj.2016.57.4.936.

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

• Luo Y
• Luo Y
• Li Y
• Zhou L
• Zhu Z
• Chen Y
• Huang Y
• Chen X

• KMID: 2374126
• DOI: http://doi.org/10.3349/ymj.2016.57.4.936

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.

Keyword

Helmets; continuous positive airway pressure; respiratory failure; meta-analysis; endotracheal intubation; mortality

MeSH Terms

Acute Disease
Adult
*Continuous Positive Airway Pressure
Hospital Mortality
Humans
*Oxygen Inhalation Therapy
Randomized Controlled Trials as Topic
Respiratory Insufficiency/mortality/*therapy

Figure

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  Fig. 1 Flow chart of the study selection process. RCT, randomized controlled trial.

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  Fig. 2 The reviewers made judgments about risk of bias for each item in each included study. +, low risk; ?, unclear risk; -, high risk.

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  Fig. 3 Forest plot: effect of helmet CPAP on oxygenation (PaO2/FiO2) in patients with hARF. CI, confidence interval; CPAP, continuous positive airway pressure; hARF, hypoxemic acute respiratory failure.

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  Fig. 4 Forest plot: effect of helmet CPAP on PaCO2 in patients with hARF. CI, confidence interval; CPAP, continuous positive airway pressure; hARF, hypoxemic acute respiratory failure.

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  Fig. 5 Forest plot: effect of helmet CPAP on intubation in patients with hARF. CI, confidence interval; CPAP, continuous positive airway pressure; hARF, hypoxemic acute respiratory failure.

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  Fig. 6 Forest plot: effect of helmet CPAP on in-hospital mortality in patients with hARF. CI, confidence interval; CPAP, continuous positive airway pressure; hARF, hypoxemic acute respiratory failure.

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