To the Editor Dr Patel and colleagues randomized 83 patients with acute respiratory distress syndrome (ARDS) to receive noninvasive ventilation (NIV) delivered by helmet or face mask.1 The helmet was significantly more effective in preventing the need for intubation. It was interesting that the most common cause of intubation in the helmet group was neurologic impairment (62.5%), which contrasts with our clinical experience. We speculate that an increased incidence of unrecognized co2 retention and hypercapnic encephalopathy may have occurred during the helmet NIV.
Taccone P, Chiumello D. Face Mask vs Helmet for Noninvasive Ventilation. JAMA. 2016;316(14):1496. doi:10.1001/jama.2016.13852