Helmet continuous positive airway pressure as noninvasive ventilation for COVID-19 patients; a systematic review and meta-analysis of randomized trials.

Abstract

Background: The COVID-19 pandemic has challenged healthcare systems globally, highlighting the need for effective respiratory support strategies. Helmet continuous positive airway pressure (CPAP) has emerged as a potential noninvasive ventilation (NIV) method for COVID-19 patients.

Methods: We searched PubMed, EMBASE, the Cochrane Library, and Scopus from December 1, 2019, to June 1, 2024. Randomized controlled trials (RCTs) comparing helmet CPAP therapy with standard oxygen therapy or other forms of NIV in COVID-19 patients with acute hypoxemic respiratory failure were included. Random effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (95% CIs).

Results: Three RCTs involving 580 patients were included in this analysis. There was no significant differences (P > 0.05) in mortality at 28 d (RR, 1.20; 95% CI, 0.84-1.71), 60-90 d (1.02, 95% CI, 0.75-1.37), or 180 d (0.98, 95% CI, 0.76-1.25) between the helmet CPAP group and the control group as well as similar intubation rates (RR 0.90; 95% CI, 0.73-1.10) and times to intubation. However, helmet CPAP was associated with significantly shorter ICU stays and hospital stays. The adverse event rates were similar between the groups. Patient comfort, as measured by the EQ-VAS, was significantly better with the CPAP helmet.

Conclusion: The use of helmet CPAP for the treatment of respiratory failure in patients with COVID-19 showed comparable intubation rates and shorter ICU and hospital stays without increasing mortality or adverse events. Key messages What is already known about this topic?  Noninvasive ventilation (NIV) methods, such as helmet CPAP, treat patients with acute hypoxemic respiratory failure. The effectiveness of helmet CPAP for COVID-19 patients is unknown. What this study adds?  This study shows that helmet CPAP has similar intubation and mortality rates to standard treatments in COVID-19 acute respiratory failure patients. It also highlights how helmet CPAP reduces ICU and hospital stays and improves patient comfort. How this study might affect research, practice, or policy?  The findings of this study could lead to future research into helmet CPAP approaches for COVID-19 and other respiratory failure patients. They could also influence clinical practice and healthcare policy by emphasizing helmet CPAP as a preferable noninvasive ventilation technique for similar patient populations.