Helmet noninvasive ventilation in patients with COVID-19-related acute hypoxemic respiratory failure: A Japanese single-center experience.

BACKGROUND

Experience with helmet noninvasive ventilation (NIV) for COVID-19-related acute hypoxemic respiratory failure in Asian populations is limited. In this single-center retrospective study, we describe our experience with helmet NIV in selected CPAP responders with COVID-19-related acute hypoxemic respiratory failure in Japan.

METHODS

We included adults with COVID-19-related acute hypoxemic respiratory failure treated with NIV between January 2020 and December 2023. Patients who continued facemask NIV were assigned to the facemask group and those switched to helmet NIV after continuous positive airway pressure (CPAP) titration to the helmet group. The primary endpoints in the helmet group were tracheal intubation and 28-day mortality; exploratory comparisons of physiological parameters and outcomes were performed between groups.

RESULTS

Fifty patients were included, 19 in the helmet group. In the helmet group, the tracheal intubation rate was 31.6% and 28-day mortality was 5.2%. Switching from facemask to helmet NIV significantly reduced respiratory rate and increased the ROX index, indicating improved oxygenation, without major adverse events. Compared with the facemask group, the helmet group tolerated higher CPAP levels and had longer NIV duration, whereas intubation rates, ventilator-free days, and mortality did not differ significantly between groups.

CONCLUSIONS

Helmet NIV was feasible in a highly selected subset of patients who showed favorable responses to CPAP and was associated with improvements in oxygenation and respiratory rate. Owing to the substantial selection bias and small sample size, all between-group comparisons are exploratory and hypothesis-generating.