title: Comparison of invasive and noninvasive positive pressure ventilation delivered by means of a helmet for weaning of patients from mechanical ventilation.
abstract: OBJECTIVE
  The effectiveness of noninvasive positive pressure ventilation delivered by helmet (H-NPPV) as a weaning approach in patients with acute respiratory failure is unclear.
  
  
  METHODS
  We randomly and evenly assigned 64 patients intubated for acute respiratory failure to conventional weaning with invasive mechanical ventilation (IMV) or H-NPPV. The primary end point was a reduction in IMV duration by 6 days between the 2 groups. Secondary end points were the occurrence of ventilator-associated pneumonia and major complications, duration of mechanical ventilation and weaning, intensive care unit and hospital length of stay, and survival.
  
  
  RESULTS
  The mean duration of IMV was significantly reduced in the H-NPPV group compared with the IMV group (P<.0001), without significant difference in duration of weaning (P=.26) and total ventilatory support (P=.45). In the H-NPPV group, the incidence of major complications was less than the IMV group (P=.032). Compared with the H-NPPV group, the IMV group was associated with a greater incidence of VAP (P=.018) and an increased risk of nosocomial pneumonia (P=.049). The mortality rate was similar between the groups, with no significant difference in overall intensive care unit (P=.47) or hospital length of stay (P=.37).
  
  
  CONCLUSIONS
  H-NPPV was well tolerated and effective in patients who were difficult to wean.
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy. Electronic address: michele.carron@unipd.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Carron
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Carollo
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Padova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011014:Pneumonia / Q000209:etiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology*; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D015300:Ventilator Weaning / Q000295:instrumentation* / Q000379:methods
keywords: Helmet; Mechanical ventilation; Noninvasive ventilation; Pneumonia; Respiratory failure; Ventilation-pressure support; Weaning