Continuous positive airway pressure ventilation with helmet in infants under 1 year

Milési, Christophe; Ferragu, Félicie; Jaber, Samir; Rideau, Aline; Combes, Clémentine; Matecki, Stéfan; Bourlet, Jacques; Picaud, Jean‐Charles; Cambonie, Gilles

doi:10.1007/s00134-010-1940-3

Cited by 31 publications

(30 citation statements)

References 19 publications

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“…[7] The results obtained in our study show that the sound pressure levels generated by the DimAir and the StarMed helmet model at 20 l/min without a diffuser were 65.13 ± 1.15 and 61.40 ± 1.40 dBA, respectively. These sound pressure levels are significantly lower than those reported by other authors, ranging between 81 (77–94)[21] and 94.4 ± 1.6 dBA. [6] Differences might be explained by the helmet design used in each study.…”

Section: Discussioncontrasting

confidence: 72%

Effect of Filters on the Noise Generated by Continuous Positive Airway Pressure Delivered via a Helmet

et al. 2017

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Introduction:One of the problems that the delivery of continuous positive airway pressure (CPAP) via a helmet poses is the generation of noise. The objective of our study was to assess the effect that the use of filter has on sound pressure levels generated by the delivery of positive airway pressure at different gas flow rates.Materials and Methods:Sound pressure levels generated by neonatal helmet CPAP delivery were measured at different gas flows (20, 30, and 40 l/min) with and without a breathing filter. Noise intensity was measured by installing microphones in the inner ear of dummy heads wearing helmets.Results:The sound pressure level increased by 38% at a gas flow of 40 l/min, as compared to a gas flow of 20 l/min {74 dBA [interquartile range (IQR) 2,2] vs 52 dBA (IQR 5,9), respectively}. Using the breathing filter as a diffuser has a variety of effects on sound pressure levels according to the gas flow rate.Conclusion:The intensity of the noise generated by helmet delivery of positive airway pressure depends on the type of helmet used, gas flow, and use or not of a diffuser filter. Breathing filters with gas flows over 30 l/min might not be recommended since they would not attenuate but will rather amplify sound pressure.

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Section: Discussioncontrasting

confidence: 72%

Effect of Filters on the Noise Generated by Continuous Positive Airway Pressure Delivered via a Helmet

et al. 2017

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“…18 CPAP by helmet was also effective and well tolerated in hypoxemic children with parenchymal disease and in infants with RSV bronchiolitis, with less need for sedation and longer application time. [21][22][23] Evaluation of comfort in infants during NRS is not standardized and, to our knowledge, no specifically designed score has yet been published. OPS is easy to apply and we chose it to reduce the risk of bias due to interobserver variability across nurses in different units.…”

Section: Discussionmentioning

confidence: 99%

“…The helmet is supposed to have several advantages over nasal or whole-face masks: it allows free movement of the infant's head as well as a good interaction with the environment while maintaining a good seal without compression. [19][20][21][22][23] In preterm infants with mild respiratory distress, CPAP by helmet resulted in better tolerance and less oxygen desaturation than use of nasal prongs. 17 In preschool children with ARF of mixed etiologies, CPAP by helmet was safe and well tolerated and resulted in an early increase in oxygenation.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16] A pediatric helmet has been used to deliver CPAP in neonates, infants, and preschool children with ARF. [17][18][19][20][21][22][23] In this population, CPAP by helmet was better tolerated than a facial mask, with no major complications and less need for sedation. [21][22][23] The aim of this prospective multicenter randomized controlled trial (RCT) was to compare the failure rates of helmet and facial mask CPAP in infants admitted to a PICU for RSVrelated ARF.…”

Section: Respiratory Syncytial Virus (Rsv)mentioning

confidence: 99%

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Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

et al. 2015

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BACKGROUND: Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS:In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface.RESULTS: Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks.CONCLUSIONS: These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting. WHAT'S KNOWN ON THIS SUBJECT:In a previous short-term physiologic randomized controlled trial, continuous positive airway pressure by helmet was feasible and efficient in improving gas exchange in pediatric acute respiratory failure due to bronchiolitis. WHAT THIS STUDY ADDS:Continuous positive airway pressure administered by helmet reduces the rate of noninvasive respiratory support failure and provides longer application time with less sedation than a facial mask. In addition, it is safe to use and free from adverse events.

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“…However, pediatric application of NIV has been limited by the lack of availability of these interfaces. This has led to the need for custom fitted masks [1], nonconventional interfaces such as helmets [2,3], or failure of this approach to ventilatory support when such masks are unavailable. These issues are compounded by the fact that because of the more diverse population, infrequent mortality, and shorter duration of mechanical ventilation, fewer randomized controlled trials (RCTs) are available in pediatric patients than adults [4].…”

Section: Introductionmentioning

confidence: 99%

Advances in Ventilatory Support of Critically Ill Children

Chipman

Kacmarek

2012

Curr Pediatr Rep

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Advances in pediatric medical practices often lag behind the progress made in adult patients, primarily because of the limited number of randomized, controlled, clinical trials. Recent advances in mechanical ventilation derived from successful application in adults include neurally adjusted ventilatory assist, noninvasive ventilation, and protective lung strategies. NAVA improves patient/ ventilator synchrony and reduces the work of breathing, which allows for a decreased use of sedation. This should decrease the length of time patients are intubated and mechanically ventilated. The use of noninvasive ventilation eliminates the need for endotracheal tubes and complications associated with them including tracheal injury, pressure ulcers, issues with oral hygiene and ventilator associated pneumonia. Application of lung protective strategies to pediatric patients with acute lung injury and/or ARDS results in increased oxygenation, less lung injury, and improvements in morbidity and mortality.

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Continuous positive airway pressure ventilation with helmet in infants under 1 year

Abstract: The helmet was a satisfactory interface for CPAP delivery in young infants in more than two-thirds of the cases. Pressure sores can be prevented by placing a cushion in the helmet. Caregivers need to take into account the high humidity and noise levels of this interface.

Cited by 31 publications

References 19 publications

Effect of Filters on the Noise Generated by Continuous Positive Airway Pressure Delivered via a Helmet

Effect of Filters on the Noise Generated by Continuous Positive Airway Pressure Delivered via a Helmet

Continuous Positive Airway Pressure With Helmet Versus Mask in Infants With Bronchiolitis: An RCT

Advances in Ventilatory Support of Critically Ill Children

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