Prophylactic Helmet NIV versus Facemask NIV on Extubation Success in Nonsurgical Postextubation Patients with Preexisting Cardiac Disease
Napat Jirawat, MD, MSc1, 2, Napplika Kongpolprom, MD, MSc2
Affiliation : 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
Background: Noninvasive ventilation (NIV) prevents postextubation respiratory failure among high-risk patients. While clinical trials have
shown no statistical significance in extubation success between facemask NIV and helmet NIV, subgroup analysis among high-risk patients with preexisting cardiac disease did not reveal conclusive evidence.
Objective: To assess the subgroup analysis of patients with preexisting cardiac disease in extubation success rate within the first 48 hours between helmet NIV and facemask NIV.
Materials and Methods: A retrospective cohort study from a randomized control trial examined patients at high-risk for extubation failure due to preexisting cardiac disease between June 2022 and June 2023. The primary outcome was extubation success within the first 48 hours. Secondary outcomes included reintubation rate within 7 days, NIV intolerance rate, complications, comfort score, and hemodynamic and gas exchange parameters during the study period.
Results: Among the 114 patients, 44 met the criteria for high-risk extubation failure due to preexisting cardiac disease (19 had facemask NIV, 25 used helmet NIV). Baseline characteristics showed no significant differences between the two groups, except for age (76.58±10.41 versus 67.08±16.75, p=0.04) and APACHE II score (16.58±1.77 versus 14.88±2.42, p=0.02). The extubation success rate was comparable between the two groups (helmet NIV, 84%; facemask NIV, 89.47%; p=0.68). The pressure support setting was higher in helmet NIV than in facemask NIV (12.36±2.69 versus 8.32±2.10; p<0.001). Helmet NIV showed lower air leakage from baseline to 24 hours after extubation compared to facemask NIV (p<0.001). NIV intolerance rate was significantly higher in the helmet group than in the control group (80% versus 21.05%, p<0.001). No intergroup differences were observed in pH, PaO2/FiO2, and PaCO2. The reintubation rate within 7 days was identical between the groups. The incidence of adverse events related to pressure sores was lower but higher concerning noise in the helmet group than in the facemask group (p<0.001).
Conclusion: In the subgroup analysis focusing on preexisting cardiac disease in individuals at high-risk for postextubation respiratory failure, helmet NIV did not significantly differ in the extubation success rate compared with facemask NIV.
Received 2 May 2024 | Revised 7 August 2024 | Accepted 10 September 2024
Keywords : Helmet NIV; Facemask NIV; High-risk extubation failure; Extubation success, Preexisting cardiac disease
