Background: Noninvasive ventilation plays a vital role in preventing post-extubation respiratory failure in high-risk groups, particularly facemask NIV, but helmet NIV use after extubation is still unproven.

Objective and Methods: This was a single-center randomized controlled trial to assess extubation success in patients at high risk of developing post-extubation respiratory failure between helmet NIV and facemask NIV immediately after extubation for 24 hours. The primary outcome was extubation success within the first 48 hours. Secondary outcomes included reintubation rate within seven days, rate of NIV intolerance, complications, comfort score, and hemodynamic and gas exchange parameter during the study period.

Results: 90 patients were enrolled. The extubation success was similar in the two groups (88.64% in helmet NIV versus 89.13% in facemask NIV). Pressure support use in helmet NIV was more than facemask NIV (P value < 0.05), as well as lower air leakage in helmet NIV compared with facemask NIV (P value <0.05). There was a significant rate of NIV intolerance in the helmet group compared with the control group (86.36% versus 19.57%, P value < 0.05). The adverse event in pressure sore and asynchrony was lower in the helmet but higher in noise compared with facemask NIV. (P value < 0.05) No intergroup differences between pH, PaO₂/FiO₂, and PaCO₂.

Conclusion: In patients with a high risk of extubation failure, the use of helmet NIV promptly after extubation was similar to the facemask NIV in the extubation success rate.