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Received Aug 21, 2017; Accepted Jan 4, 2018
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1. Introduction
Our population is aging, hospital admissions are getting more frequent with a longer length of stay (LOS), intensive care and hospital occupancy rates are climbing, and healthcare-associated expenditures are increasing [1, 2]. Intensive care costs alone totalled 108 billion US dollars in 2010, nearly double that of 2000 (56 billion US dollars). ICU costs account for 13.2% of hospital expenditures and 0.72% of the gross domestic product in the United States, a 32% percent rise from 2000 to 2010 [1, 2]. It is estimated that a single day in the intensive care unit (ICU) costs 2500–4300 US dollars per patient, representing a 61.1% increase in costs over the same time period with the use of new medications, technologies, and specialized care [1–4]. Moving forward, finding ways to reduce ICU costs will reduce the financial burden of increasing utilization of ICU care. New practices focusing on cost-effectiveness will be key by evaluating the effectiveness of the practice on patient outcomes as well as the resources required to implement it [5].
Acute respiratory distress syndrome (ARDS) has a worldwide prevalence of 10.4% in ICUs and an overall 28-day mortality of 34.8% [6]. In the absence of a proven mortality benefit, noninvasive ventilation (NIV) is used in up to 30% of patients with ARDS [6–8]. In June 2016, Patel et al. published the first randomized controlled trial comparing helmet and face mask NIV for patients with ARDS [7]. The patients who received helmet NIV had a reduction in intubation rates, ICU LOS, and 90-day mortality, as well as increased ventilator-free days. Intubation rates were 61.5% in the face mask group, as opposed to 18.2% in the helmet group, giving an absolute risk reduction of 43.3% (95% CI 24.3–62.4%,
Increased ventilator days are associated with longer LOS, higher risk of complications of intubation in ARDS such as pneumonia [9], delirium [10], and ICU-acquired weakness [11],...