OBJECTIVES : - To evaluate the clinical effectiveness continuous positive airway pressure (CPAP) with helmet in patients with acute respiratory failure.

METHODS : - A computerized search of PubMed, Google Scholar and Cochrane was done from 1966 through August 2020, followed by analysis of the text words contained in the title and abstract. Secondly search using all identified keywords and index terms was done across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies. Studies in English language, were considered. Quantitative data was pooled in statistical meta-analysis using Cochrane Review Manager (RevMan). Effect sizes expressed as risk ratio with 95% confidence intervals was calculated for analysis.

RESULTS- A total of 15 studies were included in this analysis. Use of the helmet was associated with lower hospital mortality, intubation rate, complications, increased oxygenation and reduces average length of stay. Risk Ratio for mortality {0.57, 95% CI (0.42 to 0.78) p=0.0004)}, for intubation {0.43, 95% CI (0.33 to 0.55), p=0.00001)}, for complications {0.79, 95%CI (0.59 to 1.04), p=0.09)}.

CONCLUSIONS : -The application of CPAP with the helmet can represent a valid pulmonary support in the adequate setting and with simple monitoring tools. A careful CPAP titration can optimize the recruitment of unventilated lung regions and improve hypoxemia, making it a suitable bridge to ICU or a supportive treatment to improve patients’ outcomes. A better tolerability of the helmet and a reduced room contamination compared with oronasal masks may also improve patients’ clinical management, increasing the safety of the healthcare workers involved in the assistance during the COVID-19 pandemic. The use of CPAP with helmet interface, when compared to the other standard therapies in the management of patients with ARDS, reduces intubation rates, mortality, complications, increases oxygenation and reduces and hospital costs.