Who can use a helmet for noninvasive ventilation?

Certain criteria are necessary to be able to successfully use helmet-based ventilation with patients.

The criteria for exclusion include:

• Cardiopulmonary arrest

• Glascow coma scale <8

• Absence of airway protective gag reflex

• Elevated intracranial pressure

• Tracheostomy

• Upper airway obstruction

• Pregnancy

• Patients who refuse to undergo endotracheal intubation, whatever the initial therapeutic approach

Patients who can benefit from helmet ventilation are those who have the following:

• Hypoxemic failure due to cardiac pulmonary edema and non-cardiogenic acute hypoxemic respiratory failure (AHRF) and/or

• Shock and/or

• Ventilatory failure due to chronic obstructive pulmonary disease (COPD)/asthma

Additional inclusion criteria include:

• Intact airway protective gag reflex

• Able to follow instructions (e.g. squeeze hand on command, make eye contact with care provider, stick out tongue on command)

For patients who fail helmet ventilation and need to be intubated, the following predetermined criteria include:

• Inability to achieve an arterial oxygen saturation by pulse oximetry or arterial blood gas ≥ 88%

• Respiratory rate > 36 breaths/min

• Loss of ability to maintain ventilation to keep arterial blood pH ≥ 7.20

• Loss of protective airway gag reflex (seizure disorder, severe encephalopathy, Glascow Coma Scale <8)

• Respiratory or cardiac arrest

• Intolerance of the helmet or face mask

• Development of airway bleeding, persistent vomiting and development of copious tracheal secretions