![]() ![]() ![]() This increased mortality may be due to delays in endotracheal intubation and the possible occurrence of patient self-inflicted lung-injury during the treatment. However, intubation is needed in a significant proportion of patients with AHRF treated with noninvasive support (30–60%), and is associated with higher mortality. Avoidance of intubation through noninvasive support improves patient outcomes by preventing the complications of invasive mechanical ventilation. The role of non-invasive respiratory support in the management of acute hypoxemic respiratory failure (AHRF) is unclear, but evolving. The potential superiority of helmet support for reducing the risk of intubation has been hypothesized in small, pilot randomized trials and in a network metanalysis. This improves oxygenation, limits ventilator inhomogeneities, and may attenuate the potential harm of lung and diaphragm injury caused by vigorous inspiratory effort. Preliminary data suggest that helmet noninvasive ventilation (NIV) may provide physiological benefits compared to other noninvasive oxygenation strategies (conventional oxygen, facemask NIV, high-flow nasal oxygen) in non-hypercapnic patients with moderate-to-severe hypoxemia (PaO 2/FiO 2 ≤ 200 mmHg), possibly because higher positive end-expiratory pressure (10–15 cmH 2O) can be applied for prolonged periods with good tolerability. The helmet interface allows continuous treatments with high positive end-expiratory pressure with good patient comfort. Continuous positive-airway pressure is delivered through a high-flow generator or a Venturi system connected to the inspiratory port of the interface, and a positive end-expiratory pressure valve place at the expiratory port of the helmet alternatively, pressure-support ventilation is delivered by connecting the helmet to a mechanical ventilator through a bi-tube circuit. In hypoxemic patients, helmet can facilitate noninvasive application of continuous positive-airway pressure or pressure-support ventilation via a hood interface that seals at the neck and is secured by straps under the arms. Helmet use requires specific settings. ![]()
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