Helmet Ventilation in a Child with COVID‐19 and Acute Respiratory Distress Syndrome

Abstract

Background. In pediatric patients with severe COVID‐19, if the respiratory support provided using high‐flow nasal cannula (HFNC) becomes insufficient, no definitive evidence exists to support the escalation to noninvasive ventilation (NIV) or mechanical ventilation (MV). Case Presentation. A 9‐year‐old boy being treated with face mask‐delivered biphasic positive airway pressure ventilation developed fever, tachypnea, and frequent desaturation. The COVID‐19 polymerase chain reaction test and urine antigen test for Streptococcus pneumoniae were both positive, and sputum culture yielded Pseudomonas aeruginosa. The do‐not‐resuscitate order precluded the use of endotracheal intubation. After 2 h of HFNC support, the respiratory rate oxygenation (ROX) index declined from 7.86 to 3.71, indicating impending HFNC failure. A helmet was used to deliver NIV, and SpO2 was maintained at >90%. Dyspnea and desaturation gradually improved, and the patient was switched to HFNC 6 days later and discharged 10 days later. Conclusion. In some cases, acute respiratory distress syndrome severity cannot be measured using the oxygenation index or oxygenation saturation index, and the SpO2/FiO2 ratio and ROX index may serve as useful alternatives. Although NIV delivered through a facemask or HFNC is more popular than helmet‐delivered NIV, in certain circumstances, it can help escalate respiratory support while providing adequate protection to healthcare professionals.