HELMET NON-INVASIVE VENTILATION IN ACUTE RESPIRATORY FAILURE: A SYSTEMATIC REVIEW, CASE SERIES AND PILOT FEASIBILITY TRIAL
Notice bibliographique
Résumé
This thesis consisted of three related studies presented as three separate manuscripts (one published in a peer-reviewed journal, one submitted for publication to a peer reviewed journal and one ongoing). The overarching theme of this thesis was to assess helmet non-invasive ventilation (NIV) as a new modality of NIV for the treatment of acute respiratory failure in the intensive care (ICU) setting. Our first manuscript is a published systematic review and meta-analysis that compared helmet NIV to facemask NIV and high flow nasal cannula (HFNC) in adult patients with acute respiratory failure. We performed an extensive search and included 16 randomized control trials (RCTs) and 8 observational studies, the results of which we pooled separately. We assessed certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Pooled data from RCTs suggested that helmet NIV may reduce mortality and intubation when compared to facemask NIV, albeit based on low certainty evidence. Data from observational studies supported this finding but were of even lower certainty. Given the above findings, we concluded that a large randomized control trial (RCT) that compared helmet to facemask NIV for patients with acute respiratory failure (ARF) is needed. Since helmet NIV is a new technology, before embarking on this large trial, we recognized that it was necessary to establish familiarity with the device and conduct a pilot feasibility trial. Manuscript # 2 was a 16 patient case series that characterized introduction of the helmet NIV at 2 centres (one in Canada and one in the United States). All patients who were admitted with ARF over a 7 month time period and for whom the clinical team determined that helmet NIV may be beneficial were enrolled in the trial. The most common reason for helmet NIV usage was pneumonia, especially due to COVID-19. Most patients tolerated helmet NIV and no adverse events were recorded with the device. This case series has been submitted to a peer reviewed journal for review. After the case series had concluded and staff were introduced to helmet NIV, we initiated an ongoing single centre pilot feasibility RCT comparing helmet to facemask NIV in patients with ARF (manuscript #3). This pragmatic, unblinded, concealed allocation, parallel-group trial is currently being implementedat the Juravinski Hospital and will include 50 patients. The pilot trial will examine feasibility outcomes includingrecruitment rate and protocol adherence rate. While still ongoing, current feasibility goals have been met, although we noted a high crossover rate and decreased enrollment during the peak of the most recent COVID wave. These considerations have necessitated modifications to the protocol including planned enrollment of a second site, increased site education and new incentives for healthcare workers to enroll patients in the study. Funding for this trial was provided by securing 2 peer reviewed grants totalling $75,000. Together, all 3 manuscripts represent an ongoing, cohesive research program aimed at assessing implementation and adoption of new technology in the ICU. Further projects examining the cost-effectiveness of this new technology, qualitative patients and healthcare worker experiences, as well as the aforementioned large multicentre RCT are planned moving forward.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,024 | 0,055 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,011 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».