Face Mask vs Helmet for Noninvasive Ventilation

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).