| BackgroundNoninvasive ventilation(NIV)has proved to be a useful technique for respiratory support without establishing an invasive artificial airway.NIV may be a safe and effective method of assisted ventilation in acute respiratory failure(ARF)patients with clear conscious and cooperative,whereas the application of NIV is still controversial.The effects of NIV are associated with the underlying cause of ARF,the severity of the patients' disease,whether to combine with multiple organ dysfunction,and the multiple technical causes including the NIV interface.The ventilator was connected to a patient via a nasal mask or facial mask,which was essential to ensure the successful implementation of the NIV technique.Despite great improvements in the material quality,shape,size,and fixing system of the mask,complications such as skin lesions,ulcerations of the nose bridge,eye irritation,air leakage,sputum clearance disorder,and gaseous distention were very common.The complications might result in the intolerance of patients and fail in 18%of cases.In recent years,the new helmet was developed,which did not come into contact with the patient's face and not limited to face morphology including facial deformity,edentulous teeth,or maxillofacial trauma.The helmet considerably improved patients,tolerance and compliance.The studies showed that NIV using a helmet has better tolerance and lower complications compared with NIV using a facial mask in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),acute cardiogenic pulmonary edema(ACPE),and immunocompromised ARF.Nevertheless,there is no evidence for randomized controlled studies until now.Presently,there have been fewer studies on the effect of NIV using a helmet in critically ill patients,especially in patients with multiple injuries involving chest trauma.ObjectiveTo explore whether NIV using a helmet reduces the incidence of complications related to NIV and the effect of NIV using a helmet on clinical efficacy,patients'tolerance,and prognosis compared with NIV using a facial mask in patients with ARF caused by different etiologies.MethodPatients with ARF meeting the inclusion criteria were recruited from September 2018 to January 2020 in Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University.Patients with ARF were distributed to four subgroups according to their different etiologies.The randomized allocation scheme for each subgroup was formulated based on the stratified block randomized control method.Each assignment was saved in a consecutively numbered,opaque,sealed envelope.The corresponding randomization scheme was used to allocate patients to a certain group(the helmet group or facial mask group).Based on conventional drug therapy,pressure support mode was performed in both groups.The helmet or facial mask was connected to the ventilator via a standard respiratory circuit.The complications related to NIV in both groups were observed and recorded.Oxygenation index(PaO2/FiO2),arterial carbon dioxide partial pressure,and respiratory rates were measured before and after the treatment,and the data were compared and analyzed by the repeated measures ANOVA.Tolerance score at each observation time point,duration of NIV,ICU length of stay,intubation rate,and hospital mortality of the two groups were recorded.ResultsIn all,225 patients meeting the clinical diagnosis were screened.97 patients with invasive mechanical ventilation indications and refusal to participate in this study were excluded.In the end,128 patients with ARF according to the inclusion criteria were recruited and randomized to the two groups.Among these,64 patients were assigned to the helmet group and the facial mask group.The underlying cause of ARF including chest trauma,AECOPD,ACPE,and severe pneumonia.The subgroups were chest trauma group(29 cases with helmet and 30 cases with facial mask),AECOPD group(16 cases with helmet and 15 cases with facial mask),ACPE group(14 cases with helmet and mask,respectively)and severe pneumonia group(5 cases with helmet and facial mask,respectively).Baseline characteristics were compared between the two groups(P>0.05).This study showed that NIV using a helmet significantly reduced the complications related to NIV compared with NIV using a facial mask in patients with ARF(P<0.001);Subgroup analysis including patients with chest trauma showed that NIV using a helmet significantly reduced the complications compared with a facial mask(P=0.004);Patients in the helmet were better tolerated than those in the facial mask group[ratio of good tolerance 92.1%(59/64)vs 73.4%(47/64)(P-0.005)and fully tolerance 68.7%(44/64)vs 35.9%(23/64)(P<0.001)];Pa02/FiO2 significantly increased at 1 h,4 h and at the end of NIV treatment compared with that before NIV in the helmet and facial mask groups(P<0.05),whereas there was no significant difference within the two groups(P>0.05);The chest trauma subgroup showed that PaO2/Fi02 significantly increased at 1 h,4 h and at the end of NIV treatment compared with that before NIV in the helmet and facial mask groups.Compared with the facial mask group,PaO2/FiO2 were significantly improved in the helmet group(P<0.05);There were no significant differences in the duration of NIV,ICU length of stay,intubation rate and hospital mortality between the two groups(P>0.05).ConclusionNIV using a helmet significantly reduced the complications related to NIV and improved patients' tolerance compared with NIV using a facial mask in patients with ARF.The clinical efficacy of improving blood gas exchange and relieving dyspnea were similar in both groups.In patients with chest trauma,NIV using a helmet could significantly reduce complications and improve PaO2/FiO2 compared with NIV using a facial mask.NIV using a helmet may provide another appropriate strategy of ventilatory support in patients with ARF caused by chest trauma. |
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