Helmet Noninvasive Ventilation Helped Patients with COVID-19 Avoid Intubation

Patricia Kritek, MD


Researchers found no difference in mortality or days free of respiratory support but less need for invasive ventilation.


Patients with hypoxemic respiratory failure are treated with supplemental oxygen, often high flow, with progression to invasive ventilation if hypoxemia worsens. Whether some patients could be supported with noninvasive ventilation (NIV) and avoid intubation remains a subject of debate. During the COVID-19 pandemic, interest has risen in helmet NIV as potential way to mitigate the limited supply of mechanical ventilators and minimize aerosolization of virus. This form of NIV is delivered through a helmet that surrounds the patient’s entire head and is sealed with a soft, airtight collar; helmet NIV allows easier communication with and greater comfort for the patient.


Investigators from Italy randomized 109 COVID-19 patients with hypoxemic respiratory failure to either helmet NIV or high-flow nasal cannula. Patients were supported for at least 48 hours with subsequent weaning of pressure or flow rates. Although days free of respiratory support and in-hospital mortality were similar between the two groups, patients who received NIV progressed to intubation less often (30% vs. 51%) and were less likely to have refractory hypoxemia or unbearable dyspnea. However, patients in the NIV group were more likely to receive continuous infusion of a sedative or analgesic (37% vs. 18%) and were more likely to have device-related discomfort.



This small study suggests that early use of helmet NIV for patients with hypoxemic respiratory failure helps avoid intubation. Most U.S. hospitals don’t have helmet ventilation yet, but as availability increases (and clinicians learn how to use it), it seems reasonable to try it, if patients can tolerate the interface.



Grieco DL et al. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: The HENIVOT randomized clinical trial. JAMA 2021 Mar 25; [e-pub]. (https://doi.org/10.1001/jama.2021.4682)
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