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Respiratory Support During the COVID-19 PandemicIs It Time to Consider Using a Helmet?

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Acute hypoxemic respiratory failure (AHRF) is the most common organ failure and cause of admission to the intensive care unit (ICU) among patients with COVID-19. As with all forms of AHRF, ICU management is supportive while treating the underlying cause. Because the traditional respiratory support of invasive ventilation, ie, intubation and coupling of the patient to the mechanical ventilator, carries high morbidity and mortality, less invasive respiratory support methods have been studied for decades. The overwhelming demands on ICU resources seen during waves of the SARS-CoV-2 pandemic have accelerated interest in the applicability of alternative respiratory support.

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Article Information

Corresponding Author: Laveena Munshi, MD, MSc, Mount Sinai Hospital, 600 University Ave, 18-206, Toronto, ON M5G 1X5, Canada (Laveena.munshi@sinaihealth.ca).

Published Online: March 25, 2021. doi:10.1001/jama.2021.4975

Conflict of Interest Disclosures: None reported.

References
1.
Goligher  EC , Slutsky  AS .  Not just oxygen? mechanisms of benefit from high-flow nasal cannula in hypoxemic respiratory failure.   Am J Respir Crit Care Med. 2017;195(9):1128-1131. doi:10.1164/rccm.201701-0006EDPubMedGoogle ScholarCrossref
2.
Frat  JP , Thille  AW , Mercat  A ,  et al; FLORALI Study Group; REVA Network.  High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure.   N Engl J Med. 2015;372(23):2185-2196. doi:10.1056/NEJMoa1503326PubMedGoogle ScholarCrossref
3.
Bellani  G , Laffey  JG , Pham  T ,  et al; LUNG SAFE Investigators; ESICM Trials Group.  Noninvasive ventilation of patients with acute respiratory distress syndrome: insights from the LUNG SAFE Study.   Am J Respir Crit Care Med. 2017;195(1):67-77. doi:10.1164/rccm.201606-1306OCPubMedGoogle ScholarCrossref
4.
Guan  W-J , Ni  Z-Y , Hu  Y ,  et al; China Medical Treatment Expert Group for COVID-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref
5.
Spinelli  E , Mauri  T , Beitler  JR , Pesenti  A , Brodie  D .  Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions.   Intensive Care Med. 2020;46(4):606-618. doi:10.1007/s00134-020-05942-6PubMedGoogle ScholarCrossref
6.
Amirfarzan  H , Cereda  M , Gaulton  TG ,  et al.  Use of helmet CPAP in COVID-19: a practical review.   Pulmonology. Published online February 1, 2021. doi:10.1016/j.pulmoe.2021.01.008.PubMedGoogle Scholar
7.
Patel  BK , Wolfe  KS , Pohlman  AS , Hall  JB , Kress  JP .  Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial.   JAMA. 2016;315(22):2435-2441. doi:10.1001/jama.2016.6338PubMedGoogle ScholarCrossref
8.
Ferreyro  BL , Angriman  F , Munshi  L ,  et al.  Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis.   JAMA. 2020;324(1):57-67. doi:10.1001/jama.2020.9524PubMedGoogle ScholarCrossref
9.
Grieco  DL , Menga  LS , Cesarano  M ,  et al.  Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: the HENIVOT randomized clinical trial.   JAMA. Published March 25, 2021. doi:10.1001/jama.2021.4682Google Scholar
10.
Lamontagne  F , Agoritsas  T , Siemieniuk  R ,  et al.  A living WHO guideline on drugs to prevent COVID-19.   BMJ. 2021;372(n526):n526. doi:10.1136/bmj.n526PubMedGoogle ScholarCrossref
11.
Horby  P , Lim  WS , Emberson  JR ,  et al; RECOVERY Collaborative Group.  Dexamethasone in hospitalized patients with COVID-19.   N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436PubMedGoogle ScholarCrossref
12.
Gordon  AC , Mouncey  PR , Al-Beidh  F ,  et al; REMAP-CAP Investigators.  Interleukin-6 receptor antagonists in critically ill patients with COVID-19.   N Engl J Med. Published online February 25, 2021. doi:10.1056/NEJMoa2100433PubMedGoogle Scholar
13.
Roca  O , Messika  J , Caralt  B ,  et al.  Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index.   J Crit Care. 2016;35:200-205. doi:10.1016/j.jcrc.2016.05.022PubMedGoogle ScholarCrossref
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