Helmet Non-invasive Ventilation in a Do-Not-Intubate Patient with Acute Respiratory Failure

Abstract

Non-invasive ventilation (NIV) is occasionally used for management of acute respiratory failure in a do-not-intubate (DNI) patient, when conventional oxygen administration or high-flow nasal cannula fail to improve respiratory distress. In such situations, the duration of NIV may be prolonged and cause complications due to the oro-nasal mask. The helmet can be an alternative interface to the oro-nasal mask for improving tolerability and reducing complications. Although the efficacy of helmet NIV has been demonstrated in patients with acute respiratory distress syndrome, the utility of helmet NIV in DNI patients has not been discussed. We present the case of a DNI patient with acute respiratory failure, in which helmet NIV was used instead of the conventional oro-nasal mask. Helmet NIV proved effective in preventing pressure -induced skin complications associated with oro-nasal mask NIV and relieved discomfort in this patient. Furthermore, the patient's communication ability was retained, thereby respecting the wish of the patient and his family.

Keywords

• helmet
• non-invasive ventilation
• do-not-intubate patient
• acute respiratory failure