In a comparison of ARDS patients receiving noninvasive ventilation, researchers found NIV via helmet interface resulted in a substantially lower need for intubation than NIV via face mask (18.2% vs 61.5%), according to a study published online by JAMA and presented at the American Thoracic Society International Conference.

Bhakti K. Patel, MD, and John P. Kress, MD, of the University of Chicago, and colleagues examined whether noninvasive ventilation delivered by helmet, compared with a face mask, improves intubation rate among patients with acute respiratory distress syndrome (ARDS).

Noninvasive ventilation (NIV) with a face mask is relatively ineffective at preventing endotracheal intubation (placement of a tube into the windpipe [trachea] through the mouth or nose) in patients with ARDS. Complications of endotracheal intubation include pneumonia, excessive sedation and delirium.

An alternative is to deliver NIV via a helmet interface—a transparent hood that covers the entire head of the patient with a soft collar neck seal. This interface offers several advantages over a face mask including improved tolerability and less air leak due to the helmet’s lack of contact with the face and improved seal integrity at the neck. This could reduce intubation rates and extend the benefits of NIV to more patients with ARDS.

Dr Kress and colleagues randomly assigned patients with ARDS requiring NIV delivered by face mask for at least 8 hours while in the medical intensive care unit to continue face mask NIV or switch to a helmet for NIV support. The final analysis included 44 patients randomly assigned to the helmet group and 39 to the face mask group.

The intubation rate was 61.5% for the face mask group and 18.2% for the helmet group. The median number of ventilator-free days was significantly higher in the helmet group (28 vs 12.5). At 90 days, 15 patients (34%) in the helmet group died compared with 22 patients (56%) in the face mask group. Adverse events included three interface-related skin ulcers for each group.