Respective Effects of Helmet Pressure Support, Continuous Positive Airway Pressure, and Nasal High-Flow in Hypoxemic Respiratory Failure: A Randomized Crossover Clinical Trial

Personalized noninvasive respiratory support for acute hypoxemic respiratory failure

“…The latter two modalities may be delivered by either a facemask or a helmet interface. The different devices have varying mechanisms that may impact oxygenation, ventilation, and cardiac physiology in patients with AHRF [ 2 ]. Below we summarize the most recent evidence for noninvasive respiratory support in de novo AHRF.…”

“…However, these intriguing findings led to further evaluation into the mechanisms by which the helmet interface could optimize the support of AHRF patients. These mechanisms include effective administration of higher PEEP (> 10 cmH 2 O), which may improve oxygenation and mitigate the risk of self-inflicted lung injury by inspiratory effort modulation and more homogeneous lung inflation [ 2 ]. The first head-to-head comparison of helmet NIV alternating with HFNC compared to HFNC alone in patients with COVID-19 and PaO 2 /FiO 2 < 200 mmHg (HENIVOT) found, as an exploratory outcome, lower rates of intubation in patients treated with the helmet, who received a median PEEP of 12 cmH 2 O.…”

“…NIV can decreases inspiratory effort by unloading the respiratory muscles but may increase trans-pulmonary driving pressure, especially in patients who have low inspiratory effort (< 10 cmH 2 O) during HFNC. Conversely, CPAP does not usually affect inspiratory effort and does not increase trans-pulmonary driving pressure [ 2 ].…”

“…Author details 1 Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 2 Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Fondazione 'Policlinico Universitario A. Gemelli' IRCCS, L.Go F. Vito, 00168 Rome, Italy. 3 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.…”

Long-term outcomes of patients with COVID-19 treated with helmet noninvasive ventilation or usual respiratory support: follow-up study of the Helmet-COVID randomized clinical trial

“…This is particularly relevant as noninvasive respiratory support, including noninvasive ventilation and high-flow nasal oxygen, has increasingly been used during the COVID-19 pandemic, with the premise of preventing intubation and its sequalae. Noninvasive ventilation delivered through a helmet interface has been used in patients with acute hypoxemic respiratory failure due to COVID-19 to deliver prolonged uninterrupted treatments with high positive airway pressure to reduce self-inflicted lung injury [ 7 , 8 ]. However, data on the effect of helmet noninvasive ventilation are limited to short-term mortality, and the effects on long-term mortality and quality of life in this population are unclear.…”