Efficacy of noninvasive positive pressure ventilation by helmet in adults with acute respiratory failure: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

HOU Yuying ¹ , ZHANG Caiyun ² , YUN Rongrong ³ , TIAN Jinhui ⁴ ,  ZHANG Zhigang ⁵ , YUE Weigang ⁵ , JIANG Youfei ⁵

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
2. Department of Nursing, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
3. School of Nursing, Lanzhou University, Lanzhou, 730000, P.R.China;
4. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;
5. Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding?author：

ZHANG Zhigang, Email: zzg3444@163.com

Keywords：

Helmet; Noninvasive positive pressure ventilation; Acute respiratory failure; Cohort study; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.201705018

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Objective To systematically review the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure. Methods Randomized controlled trials (RCTs) or cohort studies about noninvasive positive pressure ventilation (NPPV) by helmet in adults with acute respiratory failure were retrieved in PubMed, The Cochrane Library (Issue 11, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data databases from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Stata 12.0 software was then used to perform meta-analysis. Results A total of eight studies were included. The results of meta-analysis showed that, NPPV by helmet could significantly reduce the carbon dioxide partial pressure (cohort study: SMD=–0.46, 95%CI –0.75 to –0.18, P=0.001), tracheal intubation rate (RCT: OR=0.36, 95%CI 0.17 to 0.77, P=0.008) and hospital mortality (RCT: OR=0.48, 95%CI 0.24 to 0.98, P=0.044), improve the positive end expiratory pressure (RCT: SMD=1.27, 95%CI 0.87 to 1.67, P<0.05) and respiratory status (RCT: SMD=–0.45, 95%CI –0.81 to –0.08,P=0.017). There was no significant difference in the duration of NPPV(cohort study: OR=–0.20, 95%CI –0.50 to 0.09, P=0.177; RCT: OR=–0.24, 95%CI –0.86 to 0.38, P=0.445). Conclusion NPPV by helmet can reduce the carbon dioxide partial pressure, tracheal intubation rate, hospital mortality and improve the positive end expiratory pressure, respiratory status. But the effects in the duration of NPPV and oxygenation index are uncertain. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

Citation： HOU Yuying, ZHANG Caiyun, YUN Rongrong, TIAN Jinhui, ZHANG Zhigang, YUE Weigang, JIANG Youfei. Efficacy of noninvasive positive pressure ventilation by helmet in adults with acute respiratory failure: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(11): 1283-1290. doi: 10.7507/1672-2531.201705018 Copy

1.	Guideline BTS. Non-invasive ventilation in acute respiratory failure. Thorax, 2002, 57(3): 192-211.
2.	Nava S, Hill N. Noninvasive ventilation in acute respiratory failure. Lancet, 2009, 374(9685): 250-259.
3.	Evans TW. International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Intensive Care Med, 2001, 27(1): 166-178.
4.	Kramer N, Meyer TJ, Meharg J, et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 1995, 151(6):1799-1806.
5.	Lemyze M, Mallat J, Nigeon O, et al. Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure. Crit Care Med, 2013, 41(2): 481-488.
6.	劉奇, 陳榮昌, 程哲, 等. 頭罩無創通氣研究進展.中華結核和呼吸雜志, 2016, 39(9): 723-726.
7.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). Available at: http://handbook.cochrane.org.
8.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9.	Antonelli M, Conti G, Pelosi P, et al. New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet-a pilot controlled trial. Crit Care Med, 2002, 30(3): 602-608.
10.	Tonnelier JM, Prat G, Nowak E, et al. Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study. Intensive Care Med, 2003, 29(11): 2077-2080.
11.	Rocco M, Dell’Utri D, Morelli A, et al. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study. Chest, 2004, 126(5): 1508-1515.
12.	Conti G, Cavaliere F, Costa R, et al. Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study. Resp Care, 2007, 52(11): 1463-1471.
13.	張文梅, 沈策. 頭罩式無創正壓通氣在急性低氧性呼吸衰竭患者的臨床應用. 臨床肺科雜志, 2010, 15(1): 48-50.
14.	Brambilla AM, Aliberti S, Prina E, et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med, 2014, 40(7): 942-949.
15.	Pisani L, Mega C, Vaschetto R, et al. Oronasal mask versus helmet in acute hypercapnic respiratory failure. Eur Respir J, 2015, 45(3): 691-699.
16.	Patel BK, Wolfe KS, Pohlman AS, et al. 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.

1. Guideline BTS. Non-invasive ventilation in acute respiratory failure. Thorax, 2002, 57(3): 192-211.
2. Nava S, Hill N. Noninvasive ventilation in acute respiratory failure. Lancet, 2009, 374(9685): 250-259.
3. Evans TW. International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Intensive Care Med, 2001, 27(1): 166-178.
4. Kramer N, Meyer TJ, Meharg J, et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 1995, 151(6):1799-1806.
5. Lemyze M, Mallat J, Nigeon O, et al. Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure. Crit Care Med, 2013, 41(2): 481-488.
6. 劉奇, 陳榮昌, 程哲, 等. 頭罩無創通氣研究進展.中華結核和呼吸雜志, 2016, 39(9): 723-726.
7. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). Available at: http://handbook.cochrane.org.
8. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9. Antonelli M, Conti G, Pelosi P, et al. New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet-a pilot controlled trial. Crit Care Med, 2002, 30(3): 602-608.
10. Tonnelier JM, Prat G, Nowak E, et al. Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study. Intensive Care Med, 2003, 29(11): 2077-2080.
11. Rocco M, Dell’Utri D, Morelli A, et al. Noninvasive ventilation by helmet or face mask in immunocompromised patients: a case-control study. Chest, 2004, 126(5): 1508-1515.
12. Conti G, Cavaliere F, Costa R, et al. Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study. Resp Care, 2007, 52(11): 1463-1471.
13. 張文梅, 沈策. 頭罩式無創正壓通氣在急性低氧性呼吸衰竭患者的臨床應用. 臨床肺科雜志, 2010, 15(1): 48-50.
14. Brambilla AM, Aliberti S, Prina E, et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med, 2014, 40(7): 942-949.
15. Pisani L, Mega C, Vaschetto R, et al. Oronasal mask versus helmet in acute hypercapnic respiratory failure. Eur Respir J, 2015, 45(3): 691-699.
16. Patel BK, Wolfe KS, Pohlman AS, et al. 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.

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Efficacy of noninvasive positive pressure ventilation by helmet in adults with acute respiratory failure: a meta-analysis

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