Comparison of invasive and noninvasive positive pressure ventilation delivered by means of a helmet for weaning of patients from mechanical ventilation.

PURPOSE: The effectiveness of noninvasive positive pressure ventilation delivered by helmet (H-NPPV) as a weaning approach in patients with acute respiratory failure is unclear.

PATIENTS AND

METHODS

We randomly and evenly assigned 64 patients intubated for acute respiratory failure to conventional weaning with invasive mechanical ventilation (IMV) or H-NPPV. The primary end point was a reduction in IMV duration by 6 days between the 2 groups. Secondary end points were the occurrence of ventilator-associated pneumonia and major complications, duration of mechanical ventilation and weaning, intensive care unit and hospital length of stay, and survival.

RESULTS

The mean duration of IMV was significantly reduced in the H-NPPV group compared with the IMV group (P<.0001), without significant difference in duration of weaning (P=.26) and total ventilatory support (P=.45). In the H-NPPV group, the incidence of major complications was less than the IMV group (P=.032). Compared with the H-NPPV group, the IMV group was associated with a greater incidence of VAP (P=.018) and an increased risk of nosocomial pneumonia (P=.049). The mortality rate was similar between the groups, with no significant difference in overall intensive care unit (P=.47) or hospital length of stay (P=.37).

CONCLUSIONS

H-NPPV was well tolerated and effective in patients who were difficult to wean.