Helmet outperforms face mask noninvasive mechanical ventilation for acute respiratory failure

In patients with acute respiratory failure (ARF), helmet noninvasive mechanical ventilation (NIMV) seems superior to face mask NIMV, resulting in better tolerance and oxygenation, as well as reducing adverse events, intubation rate, and hospital mortality, reports a recent meta-analysis.

A comprehensive literature review yielded 12 eligible trials, including 569 patients, that compared helmet vs face mask NIMV in adult ARF patients. Databases accessed included PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Wanfang Data, the Chinese Biological Medicine Database, and the China Knowledge Resource Integrated Database.

Quantitative synthesis analyses showed that the incidence of intolerance was significantly lower in helmet NIMV (six studies; risk ratio [RR], 0.19, 95 percent confidence interval [CI], 0.09–0.39; p<0.001), as was the development of facial skin ulcers (seven studies; RR, 0.19, 95 percent CI, 0.08–0.43; p<0.001), and aerophagia (six studies; RR, 0.15, 95 percent CI, 0.06–0.37; p<0.001).

Notably, oxygenation index was also significantly better in patients who received helmet NIMV (mean difference, 27.76, 95 percent CI, 9.39–46.13; p<0.01).

Helmet vs face mask NIMV likewise had a better safety profile, resulting in a significantly lower intubation rate (RR, 0.39, 95 percent CI, 0.26–0.59; p<0.001) and hospital mortality (RR, 0.62, 95 percent CI, 0.39–0.99; p<0.05), without any clear between-arm difference in intensive care stay.

“In view of the possibility that the low number of patients from included studies may preclude strong conclusions, large randomized controlled trials are still needed to provide more robust evidence,” the researchers said.