Administering continuous positive airway pressure to children for acute respiratory failure with a helmet leads to lower treatment failure rates and fewer air leaks and skin sores than does using a face mask, a recent study found.

“These results suggest that helmet CPAP was better tolerated than facial mask CPAP, with less need for sedation,” reported Dr. Giovanna Chidini of Ospedale Maggiore Policlinico, Milan, and her associates. “Its application in mild pediatric acute respiratory failure is feasible and free from adverse events, thus allowing longer treatment than with the mask” (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-1142]).

The authors randomly assigned 30 infants, all experiencing mild acute respiratory failure resulting from respiratory syncytial virus (RSV), to receive CPAP from a helmet or from a face mask. Treatment failure occurred in 17% (3 of 17 infants) of those using the helmet CPAP but in 54% (7 of 13) of those receiving CPAP with a face mask, primarily because of intolerance (P = .009). Infants who did not tolerate the face mask did successfully tolerate the helmet after being switched.

All the infants receiving face mask CPAP required sedation, compared with 35% of those receiving helmet CPAP (P = .02), and more air leaks and skin sores occurred in the face mask group, despite use of protective pads. Gas exchange and breathing patterns improved equally with both CPAP methods, but all infants required intubation within the first 24 hours because of worsening gas exchange.

No major adverse events, including cardiac arrest, pneumothorax, or safety system failures, occurred in either group. Number of days on CPAP and the CPAP application time in the first 24 hours were similar across both groups. Length of stay in the pediatric intensive care unit did not significantly differ between the two groups, and no gastric distension, eye irritation, or mortality occurred in either group.

“The pediatric helmet was introduced in clinical practice to increase the infant’s comfort while on CPAP,” Dr. Chidini and her associates wrote. “The helmet is supposed to have several advantages over nasal or whole-face masks: it allows free movement of the infant’s head as well as a good interaction with the environment while maintaining a good seal without compression.” No standardized measure of comfort has yet been established, however.

The study did not receive external funding, and the authors reported no disclosures.