Noninvasive ventilation with a helmet in patients with acute respiratory failure caused by chest trauma: a randomized controlled trial

Abstract

Noninvasive ventilation (NIV) is beneficial in acute respiratory failure (ARF) caused by chest trauma; however, NIV-related complications affect the efficacy. We evaluated whether NIV with helmet decreases the incidence of complications and improves its effects in a single center. Patients with ARF after chest trauma were randomized to receive NIV with helmet or face mask. The primary outcome was the rate of NIV-related complications. Secondary outcomes were PaO2/FiO2, patient’s tolerance, intubation rate, length of intensive care unit (ICU) stay, and ICU mortality. The trial was terminated early after an interim analysis with 59 patients. The incidence of complications was lower in the helmet group [10% (3/29) vs 43% (13/30), P = 0.004], and PaO2/FiO2s were higher at 1 h and at the end of NIV (253.14 ± 64.74 mmHg vs 216.06 ± 43.86 mmHg, 277.07 ± 84.89 mmHg vs 225.81 ± 63.64 mmHg, P = 0.013 and 0.012) compared with them in face mask group. More patients reported excellent tolerance of the helmet vs face mask after 4 h of NIV [83% (24/29) vs 47% (14/30), P = 0.004] and at the end of NIV [69% (20/29) vs 30% (9/30), P = 0.03]. Differences in intubation rate, ICU stay, and mortality were non-significant (P = 0.612, 0.100, 1.000, respectively). NIV with helmet decreased NIV-related complications, increased PaO2/FiO2, and improved tolerance compared with NIV with face mask in patients with chest trauma.Trial registration: Registered in the Chinese Clinical Trial Registry (ChiCTR1900025915), a WHO International Clinical Trials Registry Platform (http://www.chictr.org.cn/searchprojen.aspx).

A pilot crossover trial assessing the exercise performance patients with chronic obstructive pulmonary disease

“…In the present study, the air leaks increased after the walk test without affecting the flow rate at peak inspiratory pressure. Although claustrophobia is the most frequently mentioned complication of HV, and is possibly unavoidable, it is not commonly reported in clinical cases 24 , 32 . Because the 6MWT is a submaximal exercise assessment, no significant change was observed in the hemodynamic outcomes of this study.…”

The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings

“…In patients with hypoxemic respiratory failure treated by PSV, helmets were effective, and tolerance was higher than it was for face masks [ 69 , 70 ]. Among hypoxemic patients affected by community-acquired pneumonia, approximately 40% of the enrolled subjects were successfully treated with helmet NPPV; poor PaO 2 /FiO 2 improvement after beginning helmet NPPV was associated with helmet failure and a subsequent need for intubation [ 71 ].…”

A systematic review and meta-analysis of different mask ventilation schemes on management of general anesthesia in patients with respiratory failure

“…After reading of full texts, research with unclear explanation and incomplete data was excluded, as were case control studies, and those with unclear grouping. Finally, total of 9 articles were included (10)(11)(12)(13)(14)(15)(16)(17)(18), involving 462 patients, with 233 patients in the hood group and 229 patients in the face mask group. The flow chart of literature retrieval and screening is shown in Figure 1, and the basic information of the included literature is shown in Table 1.…”