Dipayan Chaudhuri1,2,3, Rehman Jinah1,3, Karen E A Burns2,4,5, Federico Angriman4,6,7, Bruno L Ferreyro4,7,8, Laveena Munshi4,8, Ewan Goligher4,9,10, Damon Scales4,6,7, Deborah J Cook1,2,11, Tommaso Mauri12,13, Bram Rochwerg14,2. 1. Dept of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. 2. Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 3. These authors share first authorship. 4. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 5. Li Ka Shing Knowledge Institute, Unity Health Toronto - St Michael's Hospital, Toronto, ON, Canada. 6. Dept of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 7. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 8. Dept of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada. 9. Dept of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada. 10. Toronto General Hospital Research Institute, Toronto, ON, Canada. 11. Division of Critical Care Medicine, St Joseph's Hospital, Hamilton, ON, Canada. 12. Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 13. Dept of Anaesthesia, Critical Care and Emergency, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy. 14. Dept of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada rochwerg@mcmaster.ca.
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.
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.
Authors: Yaseen M Arabi; Sara Aldekhyl; Saad Al Qahtani; Hasan M Al-Dorzi; Sheryl Ann Abdukahil; Mohammed Khulaif Al Harbi; Eman Al Qasim; Ayman Kharaba; Talal Albrahim; Mohammed S Alshahrani; Abdulrahman A Al-Fares; Ali Al Bshabshe; Ahmed Mady; Zainab Al Duhailib; Haifa Algethamy; Jesna Jose; Mohammed Al Mutairi; Omar Al Zumai; Hussain Al Haji; Ahmed Alaqeily; Zohair Al Aseri; Awad Al-Omari; Abdulaziz Al-Dawood; Haytham Tlayjeh Journal: JAMA Date: 2022-09-20 Impact factor: 157.335
Authors: Hugo Neves; Vítor Parola; Rafael A Bernardes; Joana Sousa; Adriana Coelho; Maria Dos Anjos Dixe; Nuno Catela; Arménio Cruz Journal: Nurs Rep Date: 2022-07-17
Authors: Adrian Barnett; Richard Beasley; Catherine Buchan; Jimmy Chien; Claude S Farah; Gregory King; Christine F McDonald; Belinda Miller; Maitri Munsif; Alex Psirides; Lynette Reid; Mary Roberts; Natasha Smallwood; Sheree Smith Journal: Respirology Date: 2022-02-17 Impact factor: 6.175
Authors: Melania Cesarano; Domenico Luca Grieco; Teresa Michi; Laveena Munshi; Luca S Menga; Luca Delle Cese; Ersilia Ruggiero; Tommaso Rosà; Daniele Natalini; Michael C Sklar; Salvatore L Cutuli; Filippo Bongiovanni; Gennaro De Pascale; Bruno L Ferreyro; Ewan C Goligher; Massimo Antonelli Journal: Ann Intensive Care Date: 2022-10-14 Impact factor: 10.318