Comparison of invasive and noninvasive positive pressure ventilation delivered by means of a helmet for weaning of patients from mechanical ventilation.

PURPOSE: The effectiveness of noninvasive positive pressure ventilation delivered by helmet (H-NPPV) as a weaning approach in patients with acute respiratory failure is unclear. PATIENTS AND 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.