{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:32:40Z","timestamp":1793410360293,"version":"4.5.0"},"reference-count":66,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,2,1]],"date-time":"2020-02-01T00:00:00Z","timestamp":1580515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>High-flow nasal cannula (HFNC) and helmet noninvasive ventilation (NIV) are used for the management of acute hypoxemic respiratory failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Physiological comparison of HFNC and helmet NIV in patients with hypoxemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifteen patients with hypoxemia with PaO2\/FiO2\u2009&amp;lt;\u2009200 mm Hg received helmet NIV (positive end-expiratory pressure\u2009\u2265\u200910 cm H2O, pressure support\u2009=\u200910\u201315 cm H2O) and HFNC (50 L\/min) in randomized crossover order. Arterial blood gases, dyspnea, and comfort were recorded. Inspiratory effort was estimated by esophageal pressure (Pes) swings. Pes-simplified pressure\u2013time product and transpulmonary pressure swings were measured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>As compared with HFNC, helmet NIV increased PaO2\/FiO2 (median [interquartile range]: 255 mm Hg [140\u2013299] vs. 138 [101\u2013172]; P\u2009=\u20090.001) and lowered inspiratory effort (7 cm H2O [4\u201311] vs. 15 [8\u201319]; P\u2009=\u20090.001) in all patients. Inspiratory effort reduction by NIV was linearly related to inspiratory effort during HFNC (r\u2009=\u20090.84; P\u2009&amp;lt;\u20090.001). Helmet NIV reduced respiratory rate (24 breaths\/min [23\u201331] vs. 29 [26\u201332]; P\u2009=\u20090.027), Pes-simplified pressure\u2013time product (93 cm H2O\u2009\u22c5\u2009s\u2009\u22c5\u2009min\u22121 [43\u2013138] vs. 200 [168\u2013335]; P\u2009=\u20090.001), and dyspnea (visual analog scale 3 [2\u20135] vs. 8 [6\u20139]; P\u2009=\u20090.002), without affecting PaCO2 (P\u2009=\u20090.80) and comfort (P\u2009=\u20090.50). In the overall cohort, transpulmonary pressure swings were not different between treatments (NIV\u2009=\u200918 cm H2O [14\u201321] vs. HFNC\u2009=\u200915 [8\u201319]; P\u2009=\u20090.11), but patients exhibiting lower inspiratory effort on HFNC experienced increases in transpulmonary pressure swings with helmet NIV. Higher transpulmonary pressure swings during NIV were associated with subsequent need for intubation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As compared with HFNC in hypoxemic respiratory failure, helmet NIV improves oxygenation, reduces dyspnea, inspiratory effort, and simplified pressure\u2013time product, with similar transpulmonary pressure swings, PaCO2, and comfort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201904-0841oc","type":"journal-article","created":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T11:42:22Z","timestamp":1572954142000},"page":"303-312","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":175,"title":["Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure"],"prefix":"10.1093","volume":"201","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4557-6308","authenticated-orcid":false,"given":"Domenico Luca","family":"Grieco","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze dell\u2019Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca S.","family":"Menga","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze dell\u2019Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Raggi","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze dell\u2019Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. 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