Comparison of helmet versus face mask interface for noninvasive ventilation in patients with acute cardiogenic pulmonary oedema— A randomized controlled trial

Abstract

Introduction: Non-invasive ventilation (NIV) is strongly recommended in patients with acute cardiogenic pulmonary oedema (ACPE). Recently, helmet has been introduced as an interface for NIV. This study was planned to compare helmet and face mask interface for administering NIV. Methods: This was a prospective, randomized control trial conducted in patients with ACPE with respiratory failure treated with either face masks or helmet. Patients in Group H (Helmet) received minimum positive end expiratory pressure (PEEP) of 10, with a pressure support (PS) of 15. The cushion was inflated to 100 cm H20 and pressurization/ rise time was kept 0.1 seconds. Group F (Facemask) patients received pressure support with expiratory positive airway pressure (EPAP) of 8 and inspiratory positive airway pressure (IPAP) of 16 cm H20. EPAP & IPAP were adjusted according to tidal volume (TV) and respiratory rate (RR) respectively. Results: Patients using helmet as the interface had less failure rate (0.0%) as compared to facemask 9 (22.5%), Odds Ratio (OR)[95% Confidence Interval (CI)]- 0.04 (0.0, 0.71) (p= 0.001) and less complications such as nasal and skin ulcers 3 (8.6%) in Group H as compared to 16 (45.7%) in Group F, OR (95% CI) o--0.11 (0.03,0.43) (p= 0.01). Conclusion: Helmet was better than face mask in terms of reduced requirement of intubations, better patient tolerance and reduced complications.

Keywords

• intubation
• mask
• non-invasive ventilation
• ulcers