Exploring Factors Associated with Intolerance of Helmet Noninvasive Ventilation in High-Risk Postextubation Patients Factors Associated with Helmet NIV Intolerance in High-Risk Postextubation
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Abstract
OBJECTIVE: Studies on the use of helmet noninvasive ventilation (NIV) to prevent postextubation respiratory failure in high-risk patients are limited compared with other types of NIV. Only one randomized controlled trial (RCT) has reported that patients may have high helmet NIV intolerance. This study aimed to determine the prevalence of helmet NIV intolerance among high-risk postextubation patients and identify factors associated with this intolerance.
METHODS: This retrospective cohort study included patients at high risk of postextubation failure between June 2022 and June 2023. This study was based on an RCT that included 114 patients at high risk of postextubation failure. A subgroup analysis was performed on patients who received helmet NIV. The primary outcome was the prevalence of helmet NIV intolerance. The secondary outcome was factors associated with helmet NIV intolerance.
RESULTS: Of the 114 patients, 57 received helmet NIV. Of the 57 patients, 43 (75.4%) exhibited intolerance. A higher prevalence of cancer was observed among patients with helmet NIV intolerance, along with lower initial heart rates and higher partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratios. No significant differences in the etiology of respiratory failure or severity scores, including Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, were observed between the two groups. Additionally, the 48-h extubation success rate was comparable. Multivariate analysis revealed that a lower heart rate was a significant factor associated with helmet NIV intolerance.
CONCLUSION: During the postextubation period in high-risk patients, helmet NIV use was significantly associated with a high rate of intolerance. However, no differences in extubation success were observed. Lower initial heart rate was a significant factor associated with helmet NIV intolerance.
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References
Boscolo A, Pettenuzzo T, Sella N, Zatta M, Salvagno M, Tassone M, et al. Noninvasive respiratory support after extubation: a systematic review and network meta-analysis. Eur Respir Rev 2023;32(168):220196.
Munshi L, Mancebo J, Brochard LJ. Noninvasive respiratory support for adults with acute respiratory failure. N Engl J Med 2022;387(18):1688-98.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50(2):1602426.
Fernando SM, Tran A, Sadeghirad B, Burns KEA, Fan E, Brodie D, et al. Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis. Intensive Care Med 2022;48(2):137-47.
Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005;33(11):2465-70.
Ornico SR, Lobo SM, Sanches HS, Deberaldini M, Tofoli LT, Vidal AM, et al. Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial. Crit Care 2013;17(2):R39.
Ferrer M, Sellares J, Valencia M, Carrillo A, Gonzalez G, Badia JR, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 2009;374(9695):1082-8.
Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 2006;173(2):164-70.
El-Solh AA, Aquilina A, Pineda L, Dhanvantri V, Grant B, Bouquin P. Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients. Eur Respir J 2006;28(3):588-95.
Thille AW, Boissier F, Ben-Ghezala H, Razazi K, Mekontso-Dessap A, Brun-Buisson C, et al. Easily identified at-risk patients for extubation failure may benefit from noninvasive ventilation: a prospective before-after study. Crit Care 2016;20:48.
Grieco DL, Menga LS, Cesarano M, Rosa T, Spadaro S, Bitondo MM, et al. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: the HENIVOT randomized clinical trial. JAMA 2021;325(17):1731-43.
Chaudhuri D, Jinah R, Burns KEA, Angriman F, Ferreyro BL, Munshi L, et al. Helmet noninvasive ventilation compared to facemask noninvasive ventilation and high-flow nasal cannula in acute respiratory failure: a systematic review and meta-analysis. Eur Respir J 2022;59(3):2101269.
Liu Q, Gao Y, Chen R, Cheng Z. Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies. Crit Care 2016;20(1):265.
Chiumello D, Pelosi P, Carlesso E, Severgnini P, Aspesi M, Gamberoni C, et al. Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive Care Med 2003;29(10):1671-9.
Jirawat N, Kongpolprom N. Comparison of extubation success between prophylactic helmet NIV and facemask NIV in high-risk postextubation patients; a randomized controlled trial. Eur Respir J 2023;62 Suppl 67:OA3188.
Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 2005;293(5):589-95.
Principi T, Pantanetti S, Catani F, Elisei D, Gabbanelli V, Pelaia P, 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):147-50.
Coppadoro A, Zago E, Pavan F, Foti G, Bellani G. The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings. Crit Care 2021;25(1):327.
Rocco M, Dell'Utri D, Morelli A, Spadetta G, Conti G, Antonelli M, et al. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study. Chest 2004;126(5):1508-15.
Esquinas Rodriguez AM, Papadakos PJ, Carron M, Cosentini R, Chiumello D. Clinical review: helmet and non-invasive mechanical ventilation in critically ill patients. Crit Care 2013;17(2):223.
Amirfarzan H, Cereda M, Gaulton TG, Leissner KB, Cortegiani A, Schumann R, et al. Use of helmet CPAP in COVID-19 - a practical review. Pulmonology 2021;27(5):413-22.
