Helmet NIV vs. CPAP vs. High-flow Nasal Oxygen in Hypoxemic Respiratory Failure

Exclusion Criteria

• •Pregnancy;
• •Exacerbation of asthma or chronic obstructive pulmonary disease;
• •Hypercapnia (PaCO2\>45 mmHg) with or without respiratory acidosis;
• •More than 2 organ failures, including the lung.
• •Documented pneumothorax;
• •Clinical diagnosis of Cardiogenic pulmonary edema;
• •Haemodynamic instability (Systolic blood pressure\<90 mmHg or mean arterial pressure\<65mmHg) and/or lactic acidosis (lactate\>5 mmol/L) and/or clinically diagnosed Shock requiring administration of vasoactive agents (norepinephrine\>0.1 mcg/Kg/min);
• •Metabolic Acidosis (pH \<7.30 with normal- or hypo-carbia);
• •Chronic kidney failure requiring dialysis before ICU admission;
• •Chronic hypoxemic respiratory failure requiring long-term oxygen therapy;
• •Altered neurological status that requires immediate intubation and/or making the patient uncooperative;
• •Urgent need for endotracheal intubation, according to the decision of the attending physician;
• •Do not intubate order;
• •Decision of withdrawal of life-sustaining therapy;
• •Thoracic or abdominal surgery in the previous 7 days;
• •Any condition that makes the patient very likely to require endotracheal intubation due to a reason different from respiratory failure;
• •Recent head surgery or anatomy that prevent the application of helmet or HFNC to patient's face.