Respiratory failure & ventilation
Respective Effects of Helmet Pressure Support, Continuous Positive Airway Pressure, and Nasal High-Flow in Hypoxemic Respiratory Failure: A Randomized Crossover Clinical Trial
An erratum to this article was published (Am J Respir Crit Care Med, 1 Nov 2023 ↗)
Authors' conclusion
Compared with HFNO, helmet NIV, but not CPAP, reduced ΔPES. CPAP and NIV similarly increased oxygenation, end-expiratory lung volume, and Vt, without affecting ΔPL. NIV, and to a lesser extent CPAP, mitigated pendelluft.
Study context
- Population
- Patients with hypoxemic respiratory failure (PaO2/FiO2 ⩽ 200)crossover
- Participants
- 15 patients
- Comparison
- Helmet NIV and helmet continuous positive airway pressure (CPAP) vs high-flow nasal oxygen (HFNO)
- Primary endpoint
- Inspiratory effort (inspiratory esophageal pressure swing, ΔPES)
- Follow-up
- 1-hour phases
Methodological detailsrandomized sequence, physiological study
- Randomized sequence
- Physiological study
Primary result
As reported in the abstract
ΔPES
NIV
5
median · IQR 3–9 · cm H2O
CPAP
13
median · IQR 10–19 · cm H2O
HFNO
10
median · IQR 8–13 · cm H2O
NIV vs CPAP: P = 0.001 · NIV vs HFNO: P = 0.01
Further findings
| Outcome | Mean change (%) (95% CI) | P value | |
|---|---|---|---|
| Tidal volume (Vt, electrical impedance tomography)NIV vs HFNO | 70 (17–122%) | P = 0.02 | |
| Tidal volume (Vt, electrical impedance tomography)CPAP vs HFNO | 93 (30–155%) | P = 0.002 | |
| End-expiratory lung volumeNIV vs HFNO | 198 (67–330%) | P = 0.001 | |
| End-expiratory lung volumeCPAP vs HFNO | 263 (121–407%) | P = 0.001 | |
| −2000200400600Difference, % (linear scale) |
| Outcome | NIV | CPAP | HFNO | P value |
|---|---|---|---|---|
| PaO2/FiO2 ratioNIV vs HFNO · median | 166 (IQR 136–215) | 175 (IQR 158–281) | 120 (IQR 107–149) | P = 0.002 |
| PaO2/FiO2 ratioCPAP vs HFNO | P = 0.001 | |||
| Pendelluft involving >10% of Vt | — not stated in the abstract | — not stated in the abstract | 14 of 15 |
— not stated in the abstract
Transpulmonary pressure swing (ΔPL)
- Not statistically different between treatments
End-expiratory lung volume
- Mostly due to increased aeration/ventilation in dorsal lung regions
Pendelluft involving >10% of Vt
- Pendelluft mitigated by CPAP and further by NIV
Original publication
Respective Effects of Helmet Pressure Support, Continuous Positive Airway Pressure, and Nasal High-Flow in Hypoxemic Respiratory Failure: A Randomized Crossover Clinical Trial. Am J Respir Crit Care Med. Published 15 May 2023. doi:10.
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