Abstract
Background Although small randomised controlled trials (RCTs) and observational studies have examined helmet noninvasive ventilation (NIV), uncertainty remains regarding its role. We conducted a systematic review and meta-analysis to examine the effect of helmet NIV compared to facemask NIV or high-flow nasal cannula (HFNC) in acute respiratory failure.
Methods We searched multiple databases to identify RCTs and observational studies reporting on at least one of mortality, intubation, intensive care unit (ICU) length of stay, NIV duration, complications or comfort with NIV therapy. We assessed study risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Ottawa–Newcastle Scale for observational studies, and rated certainty of pooled evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework.
Results We separately pooled data from 16 RCTs (n=949) and eight observational studies (n=396). Compared to facemask NIV, based on low certainty of evidence, helmet NIV may reduce mortality (relative risk 0.56, 95% CI 0.33–0.95) and intubation (relative risk 0.35, 95% CI 0.22–0.56) in both hypoxic and hypercapnic respiratory failure, but may have no effect on duration of NIV. There was an uncertain effect of helmet NIV on ICU length of stay and development of pressure sores. Data from observational studies were consistent with the foregoing findings but of lower certainty. Based on low and very low certainty data, helmet NIV may reduce intubation compared to HFNC, but its effect on mortality is uncertain.
Conclusions Compared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet NIV compared to HFNC remains uncertain.
Abstract
Helmet NIV may reduce mortality and intubation when compared to facemask NIV; however, large, well-designed RCTs are needed on this topic https://bit.ly/3i1rCnS
Footnotes
The protocol for this systematic review is registered with PROSPERO (CRD42020222942)
Conflict of interest: D. Chaudhuri has nothing to disclose.
Conflict of interest: R. Jinah has nothing to disclose.
Conflict of interest: K.E.A. Burns has nothing to disclose.
Conflict of interest: F. Angriman has nothing to disclose.
Conflict of interest: B.L. Ferreyro is supported by a Vanier Canada Graduate Scholarship.
Conflict of interest: L. Munshi has nothing to disclose.
Conflict of interest: E. Goligher has nothing to disclose.
Conflict of interest: D. Scales has nothing to disclose.
Conflict of interest: D.J. Cook has nothing to disclose.
Conflict of interest: T. Mauri received personal fees from Drager, Fisher & Paykel and BBraun, all outside of the submitted work.
Conflict of interest: B. Rochwerg has nothing to disclose.
- Received May 4, 2021.
- Accepted July 17, 2021.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org