Comparison of Extubation Success between Prophylactic Helmet NIV and High-flow Nasal Cannula in Postextubation Patients at High Risk of Reintubation

<bold>Background:</bold> The use of facemask noninvasive ventilation (NIV) and high flow nasal cannula (HFNC) reduces the need for reintubation in patients with high risk factors. However, the role of helmet NIV following extubation is unknown. <bold>Objective:</bold> To compare the success rate of extubation within the first 48 hours in patients at high risk of reintubation between helmet NIV and HFNC. <bold>Methods:</bold> We conducted a single-center RCT. Patients at high risk of reintubation were randomly assigned to either helmet NIV or HFNC immediately after extubation. The primary outcome was successful extubation within the first 48 hours. Secondary outcomes were reintubation within 7 days, complications, patient comfort, and respiratory and hemodynamic parameters. <bold>Results:</bold> There were 17 eligible patients in each group, with similar baseline characteristics. There were no significant differences between the two groups in terms of the 48-hour extubation success rate (94.1% in the helmet NIV and 88.2% in the HFNC, p> 0.05) and the 7-day reintubation rate (5.9% in the helmet NIV and 11.8% in the HFNC, p> 0.05). SaO2/FiO2 in the helmet group were significantly higher throughout the study. However, the number of patients who reported discomfort and noise, as well as pressure sores, was significantly higher in the helmet NIV group. <bold>Conclusions:</bold> For patients at high risk of reintubation, the helmet NIV had no difference in extubation success rates within the first 48 hours compared to the HFNC group. <bold>Keywords:</bold> helmet NIV, HFNC, high-risk extubation failure, extubation success