Oxygen Hoods Reduced the Need for Intubation in COVID-19 Patients
Helmet based non-invasive ventilation (NIV) study at the New York hospital shows this treatment saves lives among the sickest of COVID-19 patients and adds to a growing list of research.
Oxygen hoods demonstrate significant improvement in oxygen saturation and prevent intubation in some people with acute respiratory distress, according to Dr. Owen O’Neill, MD, MPH, FUHM, founding medical director of the Department of Hyperbaric Medicine at Phelps Hospital Northwell Health.
“Mechanical ventilation and mortality rates were reduced by about 27 percent by using the hoods,” O’Neill said.
“Our study of the hoods was actually begun around the beginning of April (2020) when we had a very high incidence of COVID in the hospital,” O’Neill said.
The medical staff got interested in the hoods because they can deliver 100% oxygen without any leaks and reduce the virus spread (helmet NIV creates a closed system).
Results of the study, “The use of hyperbaric oxygen hoods as an alternative to conventional high flow oxygen delivery systems during the COVID pandemic,” were shared Nov. 12, 2020, at Associate Council Town Hall. Study author O’Neill is an assistant professor of medicine at New York Medical College and an assistant professor of emergency medicine in the Division of Undersea and Hyperbaric Medicine at Upstate Medical University. He has been practicing the specialty for more than 30 years. He is also the President & CEO of US Hyperbaric Inc., America’s leading commercial diving and tunnel medicine team.
This study involved a total of 136 patients; 58 received the hood intervention (Helmet CPAP) and 78 were in a control group. The control group included patients seen prior to hood use, and randomization wasn’t possible since it would be unethical to deny all treatment options to patients.
Hoods averted imminent intubation and mechanical ventilation in all patients. For patients about to be intubated, hood use allowed them to avoid or delay the intubation, O’Neill said. The mean improvement in post hood oxygen saturation was 8.8%.
Of the 78 in the control group, 37 (47%) needed intubation. Of the 58 who received helmet CPAP, 23 (39.7%) got intubated.
“These patients are the sickest ones,” Dr. O’Neil said. “Still, a high percent avoided intubation,” he added.
“We achieved a 27 percent risk reduction of the need for intubation,” O’Neill said. “The problem with this was it wasn’t statistically significant. … Although we didn’t reach a level of statistical significance, we did have a 27 percent risk reduction, so you can’t argue with that.”
Mortality rates also showed a 27 percent risk reduction. In the control group, 54 of 78 patients died, (69%); 36 of 58 in the hood intervention group died (62%).
The goal of any intervention was to save lives.
“When we look at intubated patients, they have up to a 97% mortality rate, so we really want to try and do whatever we can to prevent people from needing intubation,” O’Neill said. “By not intubating them right away, we decreased their mortality chances. We also gave them medications that were getting a chance to work.”
Helmet aka hood based NIV and mechanical ventilation allow patients recovery time while medications are used to treat the virus.
“It’s the bridge,” O’Neill said, giving “time for the patient to recover.”
O’Neill said they received positive feedback from some of the survivors.
“Of the ones that survived, we had a number of letters back thanking us for keeping them from being intubated. They can remember how uncomfortable they were. And when they got the hood on, they became a bit more comfortable, again enough to hold them over,” he said.
O’Neill and hospital staff faced challenges by conducting a study during a pandemic.
Hospital leaders were on their side, and one of the benefactor’s daughter provided access to 100 hoods. Staffing in the respiratory department was the most difficult challenge, he said, so the hyperbaric department halted treatment to allow staff to work on the floor and help the respiratory department.
O’Neill said it’s important to plan early. “Make the plan and follow your plan. Try and get everyone on board to follow the plan.”
He suggests early meetings with pulmonary, critical care, and anesthesia departments.
“Break out the data and show them the studies,” O’Neill said. “There’s definitely something pointing to the fact that the hood might be the better route to take.”
There’s still more work to be done. O’Neill wants to conduct a prospective randomized trial with other colleagues and hospitals who use the different interfaces for high-flow positive pressure delivery, such as face masks, nasal cannulas, and hoods, and see who does better. If multiple places participate, it would make the study statistically significant, he said.
O’Neill said his hospital is meeting to decide where and when oxygen hoods or helmets should fit into hospital policies.
“I think they are still looking at using the hoods when patients are getting bad. We’re trying to institute it as primary usage for patients having respiratory difficulty. I’d like to see the hoods used right away,” O’Neill said.