Prophylactic Helmet NIV versus Facemask NIV on Extubation Success in Postextubation Patients with Preexisting Cardiac Disease; A Retrospective Cohort Study

<bold>Background:</bold> NIV prevents post-extubation respiratory failure among patients at risk. While clinical trials revealed no difference in extubation success between facemask and helmet NIV, subgroup analysis among high-risk patients with preexisting cardiac disease showed inconclusive evidence. <bold>Objective:</bold> To assess subgroup analysis of patients with preexisting cardiac disease in 48-hour extubation success between helmet and facemask NIV. <bold>Methods:</bold> A retrospective cohort study from RCT examined patients with high-risk features during June 2022- June 2023. The primary outcome was the first 48-hour extubation success. Secondary outcomes were NIV intolerance, hemodynamic, and gas exchange parameters during the study. <bold>Results:</bold> Among the 114 patients, 44 met the criteria due to preexisting cardiac disease. Baseline characteristics showed identical between the two groups, except for age and APACHE II score(p=0.04, 0.02 respectively). The extubation success did not differ between the two groups(84.00% VS 89.47%, P=0.68). In the helmet, pressure support was higher(P<0.001) with less air leakage from baseline to 24 hours after extubation compared to facemask NIV(P<0.001). NIV intolerance was significantly higher in the helmet compared to the control group(80.00% VS 21.05%, P<0.001). No differences were observed between gas exchange, hemodynamic parameters, and 7-day reintubation rate. The pressure sore was higher but higher noise in the helmet(P<0.001) <bold>Conclusion:</bold> In the subgroup analysis focusing on preexisting cardiac disease in high-risk features, helmet NIV did not significantly differ in the extubation success compared to facemask NIV.