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Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department

Study objective: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED). Methods: Non-infer...

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Main Authors: Adi, Osman, Via, Gabriele, Salleh, Siti Hafsah, Chuan, Tan Wan, Ab Rahman, Jamalludin, Muhammad, Nik Azlan Nik, Atan, Rafidah, Anaes, M.
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Published: W B Saunders Co-Elsevier Inc 2021
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R Medicine (General)
Online Access:http://eprints.um.edu.my/33985/
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spelling my.um.eprints.339852022-06-30T06:57:35Z http://eprints.um.edu.my/33985/ Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department Adi, Osman Via, Gabriele Salleh, Siti Hafsah Chuan, Tan Wan Ab Rahman, Jamalludin Muhammad, Nik Azlan Nik Atan, Rafidah Anaes, M. R Medicine (General) Study objective: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED). Methods: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate. Results: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 +/- 3.07 to 25.43 +/- 3.11 bpm and fCPAP: from 33.46 +/- 3.35 to 27.01 +/- 3.19 bpm), heart rate (hCPAP: from 114.76 +/- 15.5 to 96.17 +/- 16.50 bpm and fCPAP: from 115.07 +/- 14.13 to 101.19 +/- 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 +/- 12.13 to 83.72 +/- 12.91 and fCPAP: from 16.01 +/- 11.76 to 76.62 +/- 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 +/- 8.06 mmHg to 166.38 +/- 30.17 mmHg in hCPAP and 68.99 +/- 7.68 mmHg to 184.49 +/- 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 +/- 13.4 to 273.4 +/- 49.5 in hCPAP and 115.0 +/- 12.9 to 307.7 +/- 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP. Conclusion: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate. (c) 2021 Elsevier Inc. All rights reserved. W B Saunders Co-Elsevier Inc 2021-11 Article PeerReviewed Adi, Osman and Via, Gabriele and Salleh, Siti Hafsah and Chuan, Tan Wan and Ab Rahman, Jamalludin and Muhammad, Nik Azlan Nik and Atan, Rafidah and Anaes, M. (2021) Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department. American Journal of Emergency Medicine, 49. pp. 385-392. ISSN 0735-6757, DOI https://doi.org/10.1016/j.ajem.2021.06.031 <https://doi.org/10.1016/j.ajem.2021.06.031>. 10.1016/j.ajem.2021.06.031
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine (General)
spellingShingle R Medicine (General)
Adi, Osman
Via, Gabriele
Salleh, Siti Hafsah
Chuan, Tan Wan
Ab Rahman, Jamalludin
Muhammad, Nik Azlan Nik
Atan, Rafidah
Anaes, M.
Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department
description Study objective: To determine whether non-invasive ventilation (NIV) delivered by helmet continuous positive airway pressure (hCPAP) is non-inferior to facemask continuous positive airway pressure (fCPAP) in patients with acute respiratory failure in the emergency department (ED). Methods: Non-inferiority randomized, clinical trial involving patients presenting with acute respiratory failure conducted in the ED of a local hospital. Participants were randomly allocated to receive either hCPAP or fCPAP as per the trial protocol. The primary endpoint was respiratory rate reduction. Secondary endpoints included discomfort, improvement in Dyspnea and Likert scales, heart rate reduction, arterial blood oxygenation, partial pressure of carbon dioxide (PaCO2), dryness of mucosa and intubation rate. Results: 224 patients were included and randomized (113 patients to hCPAP, 111 to fCPAP). Both techniques reduced respiratory rate (hCPAP: from 33.56 +/- 3.07 to 25.43 +/- 3.11 bpm and fCPAP: from 33.46 +/- 3.35 to 27.01 +/- 3.19 bpm), heart rate (hCPAP: from 114.76 +/- 15.5 to 96.17 +/- 16.50 bpm and fCPAP: from 115.07 +/- 14.13 to 101.19 +/- 16.92 bpm), and improved dyspnea measured by both the Visual Analogue Scale (hCPAP: from 16.36 +/- 12.13 to 83.72 +/- 12.91 and fCPAP: from 16.01 +/- 11.76 to 76.62 +/- 13.91) and the Likert scale. Both CPAP techniques improved arterial oxygenation (PaO2 from 67.72 +/- 8.06 mmHg to 166.38 +/- 30.17 mmHg in hCPAP and 68.99 +/- 7.68 mmHg to 184.49 +/- 36.38 mmHg in fCPAP) and the PaO2:FiO2 (Partial pressure of arterial oxygen: Fraction of inspired oxygen) ratio from 113.6 +/- 13.4 to 273.4 +/- 49.5 in hCPAP and 115.0 +/- 12.9 to 307.7 +/- 60.9 in fCPAP. The intubation rate was lower with hCPAP (4.4% for hCPAP versus 18% for fCPAP, absolute difference -13.6%, p = 0.003). Discomfort and dryness of mucosa were also lower with hCPAP. Conclusion: In patients presenting to the ED with acute cardiogenic pulmonary edema or decompensated COPD, hCPAP was non-inferior to fCPAP and resulted in greater comfort levels and lower intubation rate. (c) 2021 Elsevier Inc. All rights reserved.
format Article
author Adi, Osman
Via, Gabriele
Salleh, Siti Hafsah
Chuan, Tan Wan
Ab Rahman, Jamalludin
Muhammad, Nik Azlan Nik
Atan, Rafidah
Anaes, M.
author_facet Adi, Osman
Via, Gabriele
Salleh, Siti Hafsah
Chuan, Tan Wan
Ab Rahman, Jamalludin
Muhammad, Nik Azlan Nik
Atan, Rafidah
Anaes, M.
author_sort Adi, Osman
title Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department
title_short Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department
title_full Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department
title_fullStr Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department
title_full_unstemmed Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department
title_sort randomized clinical trial comparing helmet continuous positive airway pressure (hcpap) to facemask continuous positive airway pressure (fcpap) for the treatment of acute respiratory failure in the emergency department
publisher W B Saunders Co-Elsevier Inc
publishDate 2021
url http://eprints.um.edu.my/33985/
_version_ 1738510697693708288
score 13.211869

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