Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study.
OBJECTIVE
To compare the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet and face mask in immunocompromised patients with hypoxemic acute respiratory failure (ARF).


METHODS
Case-control study.


METHODS
The general ICU of a university hospital.


METHODS
Nineteen immunocompromised patients (hematologic malignancies [n = 8], solid-organ recipients [n = 8], AIDS [n = 3]) with hypoxemic ARF, fever, and lung infiltrates were treated with NPPV delivered by a helmet. Nineteen immunocompromised patients matched for diagnosis, age, simplified acute physiology score II, and Pao(2)/fraction of inspired oxygen (Fio(2)) receiving NPPV through a facial mask served as case-control subjects.


RESULTS
The use of NPPV delivered via helmet was as effective as NPPV delivered via face mask in avoiding endotracheal intubations (intubation rate, 37% vs 47%, respectively; p = 0.37) and improving gas exchange; 14 patients (74%) in the helmet group showed a sustained improvement in Pao(2)/Fio(2) ratio (ability to increase Pao(2)/Fio(2) ratio > 200, or an increase > 100 from the baseline) in comparison with 7 patients (34%) in the mask group (p = 0.02), whose Pao(2)/Fio(2) at treatment discontinuation was higher (p = 0.02) and had fewer complications related to NPPV (ie, skin necrosis, p = 0.01). Moreover, the patients receiving ventilation via helmet required significantly less NPPV discontinuations in the first 24 h of application (p < 0.001) than patients receiving ventilation via face mask.


CONCLUSIONS
The helmet may represent a valid alternative to a face mask in immunocompromised patients with lung infiltrates and hypoxemic ARF, increasing the patient's tolerance (ie, the number of hours of continuous NPPV use without interruptions) and decreasing the rate of complications directly related to the administration of NPPV.
Rocco
Monica
M
Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy. monica.rocco@uniroma1.it
Dell'Utri
Donatella
D
Morelli
Andrea
A
Spadetta
Gustavo
G
Conti
Giorgio
G
Antonelli
Massimo
M
Pietropaoli
Paolo
P
D016022:Case-Control Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000276:immunology / Q000628:therapy*; D016867:Immunocompromised Host; D008297:Male; D008397:Masks; D008875:Middle Aged; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000295:instrumentation*; D012131:Respiratory Insufficiency / Q000150:complications / Q000276:immunology / Q000628:therapy*