Abstract
Background Although small randomised controlled trials (RCTs) and observational studies have examined helmet non-invasive 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, ICU length of stay, NIV duration, complications, or comfort with NIV therapy. We assessed study risk of bias (ROB) using the Cochrane ROB tool for RCTs and the Ottawa-Newcastle scale for observational studies and rated certainty of pooled evidence using GRADE.
Results We separately pooled data from 16 RCTs (n=949) and 8 observational studies (n=396). Compared to facemask NIV, based on low certainty evidence, helmet NIV may reduce mortality (relative risk (RR) 0.56, 95% confidence interval (CI) (0.33 to 0.95)), and intubation (RR 0.35, 95% CI (0.22 to 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 on ICU length of stay and development of pressure sores. Data from observational studies was 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.
Conclusion Compared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet compared to HFNC remains uncertain.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dipayan Chaudhuri has nothing to disclose.
Conflict of interest: Rehman Jinah has nothing to disclose.
Conflict of interest: Karen E.A. Burns has nothing to disclose.
Conflict of interest: Federico Angriman has nothing to disclose.
Conflict of interest: Bruno Ferreyro is supported by a Vanier Canada Graduate Scholarship.
Conflict of interest: Laveena Munshi has nothing to disclose.
Conflict of interest: Ewan Goligher has nothing to disclose.
Conflict of interest: Damon Scales has nothing to disclose.
Conflict of interest: Deborah J. Cook has nothing to disclose.
Conflict of interest: Tommaso Mauri received personal fees from Drager, Fisher and Paykel, BBraun, all outside of the submitted work.
Conflict of interest: Bram Rochwerg has nothing to disclose.
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- Received May 4, 2021.
- Accepted July 17, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org