To the Editor In a single-center randomized clinical trial, Dr Patel and colleagues reported that the use of a helmet instead of a face mask to provide NIV to patients with ARDS led to an absolute decrease in the intubation rate of 43.3%.1 The authors suggested that the higher level of positive end-expiratory pressure (PEEP) sustained throughout the use of NIV and the higher ventilator fresh gas flow (to prevent co2 rebreathing) in the helmet group may explain the reduction in the intubation rate. There was however a discrepancy between the magnitude of outcome reduction and the modest difference in the levels of PEEP between helmet (8.0 cm H2O) and face mask groups (5.1 cm H2O).
Carteaux G, De Prost N, Mekontso Dessap A. Face Mask vs Helmet for Noninvasive Ventilation. JAMA. 2016;316(14):1496. doi:10.1001/jama.2016.13843