Phenotypes of COVID-19 Patients with Positive Clinical Response to Helmet Noninvasive Ventilation

This study investigates the efficacy of helmet noninvasive ventilation (NIV) compared to high-flow nasal oxygen (HFNO) alone in COVID-19 patients with moderate to severe respiratory failure. The primary outcome, 28-day respiratory support-free days, showed no significant difference between groups. However, helmet NIV resulted in lower intubation rates and more 28-day invasive ventilation-free days. Post hoc analyses identified subphenotypes benefiting more from helmet NIV, particularly patients with hypocapnia (PaCO2 < 35 mmHg) and PaO2/(FiO2 × VAS dyspnea) < 30. These findings suggest that helmet NIV may be more effective for specific patient subgroups, highlighting the importance of personalized respiratory support. Further studies are needed to confirm these results.