Background: Treatment of acute hypoxemic respiratory failure attempts to supply oxygen to the patient by non-invasive means initially (nasal cannula, non-rebreather, etc), when these treatments fail, it leads to patient sedation and intubation. There are established drawbacks of intubating patients and a focus has been placed on non-invasive ventilation delivery systems with the hope of decreasing intubation rates. The traditional facial mask has held ground as the standard of care, but newer applications including helmet delivered therapy hope to improve upon its foundation.
Methods: An exhaustive literature search using MEDLINE-Ovid, CINAHL, and Web of Science with the search words helmet, NIV, intubation, respiratory distress, and respiratory insufficiency. Quality of evidence was evaluated using the GRADE.
Results: Two studies were reviewed which analyzed patients suffering from acute respiratory failure and evaluating their need for intubation following application of either standard methods of mask NIV versus non-standard helmet NIV. After comparing the data between these studies there was a lower rate of intubation found when using helmet versus mask NIV in Antonelli et al (24% vs 32%). The second study of Chidini et al revealed similar rates of intubation when comparing helmet to mask (17% vs. 23%), but revealed a higher level of tolerance to the therapies. The overall quality of the studies was low and further studies should include a more narrow population focus.
Conclusion: Helmet NIV is as effective or in some cases more effective than mask at delivering respiratory support to patients in acute respiratory distress, and does so more tolerably to the patient.
Keywords: Intubation, respiratory insufficiency, respiratory distress, helmet, NIV
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