Exploring Factors Associated with Intolerance of Helmet Noninvasive Ventilation in High-Risk Postextubation Patients

OBJECTIVE: Studies on the use of helmet noninvasive ventilation (NIV) to prevent postextubation respiratory failure in high-risk patients are limited compared with other types of NIV. Only one randomized controlled trial (RCT) has reported that patients may have high helmet NIV intolerance. This study aimed to determine the prevalence of helmet NIV intolerance among high-risk postextubation patients and identify factors associated with this intolerance.METHODS: This retrospective cohort study included patients at high risk of postextubation failure between June 2022 and June 2023. This study was based on an RCT that included 114 patients at high risk of postextubation failure. A subgroup analysis was performed on patients who received helmet NIV. The primary outcome was the prevalence of helmet NIV intolerance. The secondary outcome was factors associated with helmet NIV intolerance.RESULTS: Of the 114 patients, 57 received helmet NIV. Of the 57 patients, 43 (75.4%) exhibited intolerance. A higher prevalence of cancer was observed among patients with helmet NIV intolerance, along with lower initial heart rates and higher partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratios. No significant differences in the etiology of respiratory failure or severity scores, including Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, were observed between the two groups. Additionally, the 48-h extubation success rate was comparable. Multivariate analysis revealed that a lower heart rate was a significant factor associated with helmet NIV intolerance.CONCLUSION: During the postextubation period in high-risk patients, helmet NIV use was significantly associated with a high rate of intolerance. However, no differences in extubation success were observed. Lower initial heart rate was a significant factor associated with helmet NIV intolerance.