Efficacy of ventilation with a helmet versus face mask in patients with acute respiratory failure: a meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Jia ¹ , ZENG Maoni ² ,  LIANG Zongan ¹

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
2. Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;

Corresponding author：

LIANG Zongan, Email: liangtiger0817@163.com

Keywords：

Helmet; Face mask; Noninvasive ventilation; Efficacy

DOI：

10.7507/1671-6205.201702026

Video：

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Objective This is a meta-analysis of the efficacy of noninvasive ventilation (NIV) with helmet compared to NIV with face mask in patients with acute respiratory failure (ARF). Methods " Helmet, face mask or facial mask” and " mechanical ventilation or noninvasive ventilation” were used as key words both in Chinese and English to search all the trials in PubMed, OVID, Embase, Scopus and Cochrane Library, websites, reference lists of articles, CNKI and Wanfang Database from inception to December 2016. Two reviewers independently assessed the methodological quality of the trials and extracted information. Revman 5.3 was used for data analysis. Results Ten randomized controlled trials (RCTs) and six case-control trials were included. NIV with a helmet reduced the intubation rate (OR=0.35, 95%CI 0.24 to 0.51, P<0.000 01), in-hospital mortality rate (OR=0.51, 95%CI 0.34 to 0.76, P=0.001), and NIV-related complications (OR=0.10, 95%CI 0.06 to 0.15, P<0.000 01) compared to NIV with face mask. There was no significant difference in gas exchange between two groups. In the subgroup analysis, types of ARF and ventilation mode did not affect the intubation rate and the complications relevant to NIV, but NIV with helmet mainly decreased the in-hospital mortality of the patients with hypoxemic ARF or pressure support ventilation. Conclusions NIV with a helmet can decrease the endotracheal intubation rate, in-hospital mortality, and NIV-related complications of the patients with ARF. And helmet is as effective as face mask in improving the gas exchange. However, larger or multicenter RCTs are needed to analyze the role of NIV with a helmet in this condition.

Citation： LI Jia, ZENG Maoni, LIANG Zongan. Efficacy of ventilation with a helmet versus face mask in patients with acute respiratory failure: a meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(2): 165-174. doi: 10.7507/1671-6205.201702026 Copy

1.	International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 2001, 163(1): 283-291.
2.	Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333(13): 817-822.
3.	Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomised controlled trial. Lancet, 2000, 355(9219): 1931-1935.
4.	Baydur A, Layne E, Aral H, et al. Long term non-invasive ventilation in the community for patients with musculoskeletal disorders: 46 year experience and review. Thorax, 2000, 55(1): 4-11.
5.	Conti G, Marino P, CogliatiA, et al. Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study. Intensive Care Med, 1998, 24(12): 1283-1288.
6.	Antonelli M, Conti G, Bufi M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA, 2000, 283(2): 235-241.
7.	Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med, 2001, 344(7): 481-487.
8.	Rocco M, Conti G, Antonelli M, et al. Non-invasive pressure support ventilation in patients with acute respiratory failure after bilateral lung transplantation. Intensive Care Med, 2001, 27(10): 1622-1626.
9.	Carlucci A, Richard JC, Wysocki M, et al. SRLF Collaborative Group on Mechanical Ventilation. Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med, 2001, 163(4): 874-880.
10.	Nourdine K, Combes P, Carton MJ, et al. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med, 1999, 25(6): 567-573.
11.	Girou E, Schortgen F, Delclaux C, et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA, 2000, 284(18): 2361-2367.
12.	Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med, 1998, 339(7): 429-435.
13.	Nava S, Ambrosino N, Clini E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med, 1998, 128(9): 721-728.
14.	Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med, 2001, 163(2): 540-577.
15.	Conti G, Antonelli M, Rocco M. Noninvasive ventilation in intensive care unit patients. Monaldi Arch Chest Dis, 2000, 55(1): 50-53.
16.	Moretti M, Cilione C, Tampieri A, et al. Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax, 2000, 55(10): 819-825.
17.	Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med, 1994, 22(8): 1253-1261.
18.	Navalesi P, Costa R, Ceriana P, et al. Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med, 2006, 33(1): 74-81.
19.	Costa R, Navalesi P, Spinazzola G, et al. Influence of ventilator settings on patient-ventilator synchrony during pressure support ventilation with different interfaces. Intensive Care Med, 2010, 36(8): 1363-1370.
20.	Chiumello D, Pelosi P, Carlesso E, et al. Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive Care Med, 2003, 29(10): 1671-1679.
21.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
22.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]. The Cochrane Collaboration, Oxford. Available from: http://www. cochrane-handbook.org.[2016-12-01].
23.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
24.	Bowden J, Tierney JF, Copas AJ, et al. Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol, 2011, 11: 41.
25.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
26.	Antonelli M, Conti G, Pelosi P, et al. New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet--a pilot controlled trial. Crit Care Med, 2002, 30(3): 602-608.
27.	Tonnelier JM, Prat G, Nowak E, et al. Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study. Intensive Care Med, 2003, 29(11): 2077-2080.
28.	Principi T, Pantanetti S, Catani F, et al. Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med, 2004, 30(1): 147-150.
29.	Antonelli M, Pennisi MA, Pelosi P, et al. Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study. Anesthesiology, 2004, 100(1): 16-24.
30.	Rocco M, Dell’Utri D, MorelliA, et al. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study. Chest, 2004, 126(5): 1508-1515.
31.	Conti G, Cavaliere F, Costa R, et al. Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study. Respir Care, 2007, 52(11): 1463-1471.
32.	Ali A, Türkmen A, Turgut N, et al. Comparison of non-invasive mechanical ventilation with helmet or face mask in patients with acute exacerbation of chronic obstructive pulmonary disease. Tuberk Toraks, 2011, 59(2): 146-152.
33.	Antonaglia V, Ferluga M, Molino R, et al. Comparison of noninvasive ventilation by sequential use of mask and helmet versus mask in acute exacerbation of chronic obstructive pulmonary disease: a preliminary study. Respiration, 2011, 82(2): 148-154.
34.	Özlem ÇG, Ali A, Fatma U, et al. Comparison of helmet and facial mask during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled study. Turk J Med Sci, 2015, 45(3): 600-606.
35.	Patel BK, Wolfe KS, Pohlman AS, et al. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA, 2016, 315(22): 2435-2441.
36.	Yang Y, Liu N, Sun L, et al. Noninvasive positive-pressure ventilation in treatment of hypoxemia after extubation following type-A aortic dissection. J Cardiothorac Vasc Anesth, 2016, 30(6): 1539-1544.
37.	张文梅, 沈策. 头罩式无创正压通气在慢性阻塞性肺疾病急性加重患者中的临床应用. 国际呼吸杂志, 2008, 28(15): 900-903.
38.	张文梅, 沈策. 头罩式无创正压通气在急性低氧性呼吸衰竭患者的临床应用. 临床肺科杂志, 2010, 15(1): 48-50.
39.	郭华, 张容, 谢明金, 等. 头罩无创正压通气治疗慢性阻塞性肺疾病急性加重期临床疗效分析. 西部医学, 2013, 25(5): 772-774.
40.	姜秀春. 探讨头罩无创正压通气治疗慢性阻塞性肺疾病急性加重期患者的临床疗效. 中外医疗, 2015, (9): 106-107.
41.	杨毅, 刘楠, 侯晓彤, 等. 无创正压通气不同界面在改善冠状动脉旁路移植术后低氧血症的研究. 心肺血管病杂志, 2016, 35(2): 110-115.
42.	Patroniti N, Foti G, Manfio A, et al. Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study. Intensive Care Med, 2003, 29(10): 1680-1687.
43.	Cavaliere F, Conti G, Costa R, et al. Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask. Intensive Care Med, 2004, 30(9): 1755-1760.
44.	Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med, 2003, 168(12): 1432-1437.
45.	Chadda K, Annane D, Hart N, et al. Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema. Crit Care Med, 2002, 30(11): 2457-2461.
46.	Racca F, Appendini L, Gregoretti C, et al. Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. J Appl Physiol (1985), 2005, 99(4): 1262-1271.

1. International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 2001, 163(1): 283-291.
2. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333(13): 817-822.
3. Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomised controlled trial. Lancet, 2000, 355(9219): 1931-1935.
4. Baydur A, Layne E, Aral H, et al. Long term non-invasive ventilation in the community for patients with musculoskeletal disorders: 46 year experience and review. Thorax, 2000, 55(1): 4-11.
5. Conti G, Marino P, CogliatiA, et al. Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study. Intensive Care Med, 1998, 24(12): 1283-1288.
6. Antonelli M, Conti G, Bufi M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA, 2000, 283(2): 235-241.
7. Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med, 2001, 344(7): 481-487.
8. Rocco M, Conti G, Antonelli M, et al. Non-invasive pressure support ventilation in patients with acute respiratory failure after bilateral lung transplantation. Intensive Care Med, 2001, 27(10): 1622-1626.
9. Carlucci A, Richard JC, Wysocki M, et al. SRLF Collaborative Group on Mechanical Ventilation. Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med, 2001, 163(4): 874-880.
10. Nourdine K, Combes P, Carton MJ, et al. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med, 1999, 25(6): 567-573.
11. Girou E, Schortgen F, Delclaux C, et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA, 2000, 284(18): 2361-2367.
12. Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med, 1998, 339(7): 429-435.
13. Nava S, Ambrosino N, Clini E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med, 1998, 128(9): 721-728.
14. Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med, 2001, 163(2): 540-577.
15. Conti G, Antonelli M, Rocco M. Noninvasive ventilation in intensive care unit patients. Monaldi Arch Chest Dis, 2000, 55(1): 50-53.
16. Moretti M, Cilione C, Tampieri A, et al. Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax, 2000, 55(10): 819-825.
17. Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med, 1994, 22(8): 1253-1261.
18. Navalesi P, Costa R, Ceriana P, et al. Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med, 2006, 33(1): 74-81.
19. Costa R, Navalesi P, Spinazzola G, et al. Influence of ventilator settings on patient-ventilator synchrony during pressure support ventilation with different interfaces. Intensive Care Med, 2010, 36(8): 1363-1370.
20. Chiumello D, Pelosi P, Carlesso E, et al. Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive Care Med, 2003, 29(10): 1671-1679.
21. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
22. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]. The Cochrane Collaboration, Oxford. Available from: http://www. cochrane-handbook.org.[2016-12-01].
23. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
24. Bowden J, Tierney JF, Copas AJ, et al. Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol, 2011, 11: 41.
25. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
26. Antonelli M, Conti G, Pelosi P, et al. New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet--a pilot controlled trial. Crit Care Med, 2002, 30(3): 602-608.
27. Tonnelier JM, Prat G, Nowak E, et al. Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study. Intensive Care Med, 2003, 29(11): 2077-2080.
28. Principi T, Pantanetti S, Catani F, et al. Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med, 2004, 30(1): 147-150.
29. Antonelli M, Pennisi MA, Pelosi P, et al. Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study. Anesthesiology, 2004, 100(1): 16-24.
30. Rocco M, Dell’Utri D, MorelliA, et al. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study. Chest, 2004, 126(5): 1508-1515.
31. Conti G, Cavaliere F, Costa R, et al. Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study. Respir Care, 2007, 52(11): 1463-1471.
32. Ali A, Türkmen A, Turgut N, et al. Comparison of non-invasive mechanical ventilation with helmet or face mask in patients with acute exacerbation of chronic obstructive pulmonary disease. Tuberk Toraks, 2011, 59(2): 146-152.
33. Antonaglia V, Ferluga M, Molino R, et al. Comparison of noninvasive ventilation by sequential use of mask and helmet versus mask in acute exacerbation of chronic obstructive pulmonary disease: a preliminary study. Respiration, 2011, 82(2): 148-154.
34. Özlem ÇG, Ali A, Fatma U, et al. Comparison of helmet and facial mask during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled study. Turk J Med Sci, 2015, 45(3): 600-606.
35. Patel BK, Wolfe KS, Pohlman AS, et al. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA, 2016, 315(22): 2435-2441.
36. Yang Y, Liu N, Sun L, et al. Noninvasive positive-pressure ventilation in treatment of hypoxemia after extubation following type-A aortic dissection. J Cardiothorac Vasc Anesth, 2016, 30(6): 1539-1544.
37. 张文梅, 沈策. 头罩式无创正压通气在慢性阻塞性肺疾病急性加重患者中的临床应用. 国际呼吸杂志, 2008, 28(15): 900-903.
38. 张文梅, 沈策. 头罩式无创正压通气在急性低氧性呼吸衰竭患者的临床应用. 临床肺科杂志, 2010, 15(1): 48-50.
39. 郭华, 张容, 谢明金, 等. 头罩无创正压通气治疗慢性阻塞性肺疾病急性加重期临床疗效分析. 西部医学, 2013, 25(5): 772-774.
40. 姜秀春. 探讨头罩无创正压通气治疗慢性阻塞性肺疾病急性加重期患者的临床疗效. 中外医疗, 2015, (9): 106-107.
41. 杨毅, 刘楠, 侯晓彤, 等. 无创正压通气不同界面在改善冠状动脉旁路移植术后低氧血症的研究. 心肺血管病杂志, 2016, 35(2): 110-115.
42. Patroniti N, Foti G, Manfio A, et al. Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study. Intensive Care Med, 2003, 29(10): 1680-1687.
43. Cavaliere F, Conti G, Costa R, et al. Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask. Intensive Care Med, 2004, 30(9): 1755-1760.
44. Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med, 2003, 168(12): 1432-1437.
45. Chadda K, Annane D, Hart N, et al. Cardiac and respiratory effects of continuous positive airway pressure and noninvasive ventilation in acute cardiac pulmonary edema. Crit Care Med, 2002, 30(11): 2457-2461.
46. Racca F, Appendini L, Gregoretti C, et al. Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. J Appl Physiol (1985), 2005, 99(4): 1262-1271.

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Efficacy of ventilation with a helmet versus face mask in patients with acute respiratory failure: a meta-analysis

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