Helmet CPAP revisited in COVID-19 pneumonia: A case series

Abstract

Introduction: Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients. Case and outcomes: This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease. Discussion: NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population. Conclusion: Helmet NIPPV is a feasible therapy to manage COVID-19 patients.

Alternative to traditional noninvasive ventilation using a modified snorkel mask in a patient with SARS-COV2: A case report

“…Among the possible dangers and limitations of the use of the snorkel mask, we find that the patient breathes the exhaled air again, which produces hypercapnia. To avoid this, flow rates (typically at least 50 L per minute) are needed to maintain adequate inspiratory positive airway pressure and expiratory positive airway pressure [ 10 – 12 ].…”

Continuous positive air pressure (CPAP) should be used in all COVID-19 patients when the first and mild respiratory symptoms commence

“…Prior to commencing BiPAP, the patient must be assessed for a pneumothorax, ideally by a chest X-Ray or ultrasound. Due to the need for chest auscultation for COVID-19 patients, is not recommended as it increases the risk of transmission to the healthcare professional [8,111,112].…”

“…The application of Positive End Expiratory Pressure (PEEP) assists in maintaining the patient's airway pressure prevents alveolar collapse, in turn increasing lung volumes and distends them to reduce the distance between the alveolar and the blood vessels to improve gaseous exchange. In severe COVID-19, initial CPAP setting have been suggested 10 cm H2O and 60% oxygen [14,110,112,[116][117][118][119][120][121][122].…”

Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak

“…[12] When treating COVID-19 affected patients, the use of helmets might bear the additional advantage of reducing virus environment contamination. [13,14] Recent reports suggest that helmet CPAP can be effective for COVID-19 treatment, [15][16][17] possibly combined with prone or lateral position. [18][19][20] In a multicenter cohort study Aliberti et al showed that helmet CPAP signi cantly increased PaO2/FiO2 from oxygen administration alone, but that treatment failure was frequent, occurring in 44% of patients who required intubation and invasive ventilation.…”

“…days, with a PEEP of 10 [5-10] cmH 2 O and a FiO 2 of 50 [35-80]%. Such patients were discharged from hospital after 14[10][11][12][13][14][15][16][17][18][19] days. Patients requiring intubation (54, 31%) showed a higher heart rate on day one than those who did not (119, 68%) (92 [83-102] BPM vs. 80 [72-90], P<0.001).…”