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Updated: Jun 23, 2026

Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

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Published on: December 5, 2025

Helmet with specific settings versus facemask for noninvasive ventilation.

Frédéric Vargas¹, Arnaud Thille, Aissam Lyazidi

¹Medical Intensive Care Unit, Albert Chenevier - Henri Mondor Teaching Hospital, Créteil Cedex, France. frederic.vargas@chu-bordeaux.fr

Critical Care Medicine

|April 23, 2009

Summary

Noninvasive pressure-support ventilation (NPSV) delivered via helmet may require adjusted settings for optimal patient-ventilator synchrony. Specific settings on the helmet improved inspiratory muscle effort and synchrony compared to a facemask.

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Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

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Published on: January 29, 2011

Area of Science:

Critical Care Medicine
Respiratory Physiology
Mechanical Ventilation

Background:

Noninvasive pressure-support ventilation (NPSV) is crucial for managing respiratory distress.
Helmet interfaces are an alternative to facemasks for NPSV delivery.
Optimizing NPSV settings is essential for patient outcomes.

Purpose of the Study:

To compare the physiological effects of NPSV delivered via facemask versus helmet.
To evaluate the impact of specific helmet settings on inspiratory muscle effort, gas exchange, and patient-ventilator synchrony.
To assess patient comfort with different NPSV interfaces.

Main Methods:

Prospective crossover study in a university hospital medical intensive care unit.
Eleven patients at risk for respiratory distress received NPSV post-extubation.
Three 20-minute NPSV periods were randomly delivered: facemask, helmet (same settings), and helmet (specific settings with increased pressure support and PEEP).

Main Results:

The helmet with standard settings increased inspiratory muscle effort and worsened patient-ventilator synchrony compared to the facemask.
Specific helmet settings (increased pressure support, PEEP, and pressurization rate) abolished the increased inspiratory muscle effort.
Specific helmet settings significantly improved triggering-on delay compared to the helmet without specific settings; tolerance was similar across interfaces.

Conclusions:

Adjusting pressure support and PEEP levels, along with utilizing the highest pressurization rate, is recommended for NPSV delivered via helmet.
Helmet ventilation with optimized settings can achieve comparable or superior physiological effects to facemask ventilation.
Further research may explore long-term outcomes with helmet-based NPSV.