Acute Respiratory Failure in the ED: Helmet vs. Facemask CPAP

CPAP Machine
CPAP Machine
Which is a better interface for patients needing noninvasive ventilation in the emergency department, hCPAP or fCPAP?

For patients presenting to the emergency department (ED) with acute respiratory failure (most notably cardiogenic pulmonary edema or acute exacerbation of chronic obstructive pulmonary disease), use of helmet continuous positive airway pressure (hCPAP) may provide greater comfort levels and result in a lower intubation rate than use of facemask continuous positive airway pressure (fCPAP), according to a study published in the American Journal of Emergency Medicine.

Noninvasive ventilation (NIV) administered in the ED may reduce the need for endotracheal intubation and admission to the intensive care unit (ICU). Although the most frequent interface used are facemasks, there have been no randomized trials comparing hCPAP and fCPAP. Therefore, researchers compared the effectiveness of helmet vs. facemask use among 224 patients (113 patients to hCPAP, 111 to fCPAP) admitted to the ED of a Malaysian hospital with hypoxemic acute respiratory failure.

The investigators found that use of hCPAP was not inferior to use of fCPAP with respect to reduced respiratory rate and heart rate, improved dyspnea, arterial oxygenation, and the PaO2:FiO2 (ratio of partial pressure of arterial oxygen to fractional inspired oxygen). Moreover, use of hCPAP was associated with a lower intubation rate (4.4% for hCPAP vs 18% for fCPAP, absolute difference −13.6%, P =.003), as well as less discomfort and dryness of mucosa.

“Our study shows that, in a mixed ED population with hypoxemic acute respiratory failure caused by cardiogenic pulmonary edema and exacerbation of [chronic obstructive pulmonary disease], hCPAP is a good alternative to fCPAP for the delivery of [positive end-expiratory pressure],” concluded the authors.


Adi O, Via G, Salleh SH, et al. Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department. Am J Emerg Med. 2021;49:385-392. doi: