Exploring Factors Associated with Intolerance of Helmet NIV in High-Risk Postextubation Patients; A Retrospective Cohort Study

<bold>Background:</bold> In patients at high risk, the helmet NIV uses for preventing postextubation respiratory failure is rarely documented compared to other interfaces. While only one randomized controlled trial (RCT) has been conducted in this population, it presents significant evidence of high intolerance to helmet NIV. <bold>Objective:</bold> To assess helmet NIV intolerance in patients at risk of extubation failure and to ascertain the variable factors associated with this condition. <bold>Methods:</bold> A retrospective cohort study (subgroup analysis) from RCT examined patients with a high risk of extubation failure in the helmet NIV. The primary outcome was the incidence of helmet NIV intolerance. Secondary outcomes encompassed variable factors associated with helmet NIV intolerance. <bold>Results:</bold> Among the cohort of 114 patients, 57 were allocated to helmet NIV, of which 75.4% (43 out of 57) exhibited intolerance. Baseline characteristics revealed a higher prevalence of cancer among patients experiencing helmet NIV intolerance, along with initial lower heart rates and higher PaO₂/FiO₂. No significant differences between the two groups were observed in the cause of respiratory failure or severity scores. Additionally, the 48-hour extubation success was comparable. Multivariable analysis identified lower heart rates as a significant factor associated with helmet NIV intolerance. <bold>Conclusion:</bold> During the postextubation period in high-risk patients, the utilization of helmet NIV was associated with a significantly high rate of intolerance; however, no variance was observed in extubation success. Notably, lower initial heart rate emerged as a notable factor linked with helmet NIV intolerance.