Influence of Humidification on Comfort During Noninvasive Ventilation With a Helmet

Ueta, Kazuyoshi; Tomita, Toshiji; Uchiyama, Akinori; Ohta, Nobuaki; Iguchi, Naoya; Goto, Yukinobu; Fujino, Yuji

doi:10.4187/respcare.01735

Cited by 18 publications

(19 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In healthy volunteers unaware of the study purposes, we found that adding HFNC to CPAP (compared to CPAP) (1) did not importantly alter either the preset airway pres- 14 (12)(13)(14)(15)(16)(17)(18)(19) 19 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 21 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) .01 †; .001* ‡; .001* § 21 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 21 (18)(19)(20)(21)…”

Section: Discussionmentioning

confidence: 95%

“…14 We also measured the temperature inside the helmet in all experimental conditions because previous work conducted on 28 healthy subjects during helmet CPAP showed that increasing temperature worsens comfort. 22 Nevertheless, it remained fundamental to determine whether and to what extent the interplay between CPAP and HFNC would alter the amount of pressure applied by CPAP. We reasoned that measuring pressure within the helmet would not provide sufficient data to answer these crucial questions and, therefore, chose to measure airway pressure within the pharynx in all experimental conditions.…”

Section: ͻ001mentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

et al. 2019

View full text Add to dashboard Cite

BACKGROUND: This study assessed the effects of a new interface that combined CPAP 10 cm H 2 O by using a helmet with high-flow nasal cannula (HFNC) at varying flows in healthy volunteers. Outcome measures included pharyngeal pressures, diaphragm kinetics, breathing frequency, the temperature inside the helmet, and comfort. METHODS: After baseline assessment during spontaneous breathing, HFNC was applied at flows of 30, 40, and 50 L/min. Successively, the volunteers underwent helmet CPAP at 10 cm H 2 O and CPAP ؉ HFNC at flows of 30, 40, and 50 L/min. We measured the variations of pharyngeal pressures at end-expiration and end-inspiration, referenced to spontaneous breathing for HFNC and to CPAP for CPAP ؉ HFNC, diaphragm displacement and thickness at end-expiration and thickness at end-inspiration, breathing frequency, the temperature inside the helmet, the occurrence of the fog effect, and comfort. RESULTS: Variations of pharyngeal pressures at end-inspiration changes were small overall and clinically unimportant. With the mouth closed, at increasing HFNC flow, variations of pharyngeal pressures at endexpiration increased during both HFNC (from 2.8 up to 7.7) and, to a lesser extent, CPAP ؉ HFNC (from 2.7 up to 3.8) (P < .001 for all comparisons). These variations were attenuated during open-mouth breathing. HFNC > 40 L/min and CPAP ؉ HFNC > 40 L/min compared with spontaneous breathing and CPAP, respectively, increased diaphragm displacement (P ‫؍‬ .001), thickness at end-inspiration and thickness at end-expiration (P < .003 for both). At all flows, breathing frequency was slightly, although significantly, lower with CPAP ؉ HFNC than with HFNC alone (P < .003). The temperature inside the helmet increased slightly and insignificantly at flows of <40 L/min with CPAP ؉ HFNC compared with CPAP alone. The fog effect never occurred, whereas comfort was always rated as optimal, without differences between trials. CONCLUSIONS: CPAP ؉ HFNC was well tolerated, with no adverse effects. Based on our findings, there was no need to vary the CPAP level when adding HFNC. At least in healthy subjects, CPAP ؉ HFNC at 30 L/min seemed to be the best combination.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: ͻ001mentioning

confidence: 99%

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The duration of CPAP therapy is also affected by the patient's compliance and tolerance. The comfort of patients during helmet CPAP can be influenced by several factors: gas flow, noise, humidity levels and fixing system (Cavaliere et al, 2008;Chiumello et al, 2008;Ueta et al, 2013). All these aspects require accurate management in order to improve the quality of comfort during the administration of helmet-CPAP (Bambi et al, 2017;Lucchini et al, 2010).…”

Section: Literature Reviewmentioning

confidence: 99%

How different helmet fixing options could affect patients' pain experience during helmet‐continuous positive airway pressure

Lucchini

Elli

Bambi

et al. 2018

Nursing in Critical Care

View full text Add to dashboard Cite

Background: Prolonged application time of helmet continuous positive airway pressure (CPAP) leads to better outcomes, but its timing can be influenced by the patient's tolerance. Aims and objectives: To investigate patients' pain and tolerance experience related to different options of helmet fixing system: 'armpits strap' versus 'counterweights system'. Design: This was a non-randomized crossover study performed in a 10-bed intensive care unit and referral extra corporeal membrane oxigenation (ECMO) centre of an Italian university hospital. Results: Twenty patients were enrolled. For helmet-CPAP cycles performed with the armpit straps option, the mean pain numerical rate on a 0-10 scale was: 0⋅5 ± 1⋅4 at T 0 (baseline) , 1⋅5 ± 2⋅0 at T 1 (after 1 h) and 2⋅6 ± 2⋅5 at T 2 (end of cycle) (p = 0⋅023). The same analysis was performed for the counterweights fixing option. The mean score was 0⋅3 ± 0⋅6 at T 0 , 0⋅3 ± 0⋅2 at T 1 and 0⋅5 ± 0⋅7 at T 2 (p = 0⋅069). The mean duration for CPAP cycles performed with armpits strap and counterweights system was 3⋅0 ± 1⋅0 and 3⋅9 ± 2⋅3 h, respectively (p < 0⋅001). The mean section of the Basilic vein that was investigated before wearing the helmet was equal to 0⋅23 ± 0⋅20 cm 2 . After 1 h of therapy with the counterweight option and armpit straps, the mean increase of the vein's section was 0⋅27 ± 0⋅21(p = 0⋅099) and 0⋅30 ± 0⋅25, respectively (p = 0⋅080). Conclusions: The fixing system options in use to anchor the helmet during CPAP could worsen the pain experience level and cause device-related pressure ulcers. When compared with the armpit straps option, the counterweights system appears to be a suitable approach to minimize the risks of pressure sores and pain during the treatment. Relevance to practice: The helmet CPAP is a reliable therapy to manage acute respiratory failure. Major improvements regarding pulmonary alveolar recruitment and oxygen levels are strictly related to a prolonged time of helmet CPAP cycles. Using a counterweight fixing system, where the armpits straps are not necessary, could be helpful in reducing patients' pain experience. Squadrone et al., 2004), but it also depends on the ventilator settings, the interfaces available (Navalesi et al., 2000) and the quality of interaction between the pulmonary ventilator and the patient's spontaneous breathing (Vignaux et al., 2009).According to Taccone et al. (2004), non-invasive CPAP should be delivered by continuous gas flow in order to avoid or minimize the mismatch of patient/ventilator interaction. Currently, in Europe, the mask interface is still the main choice, even if new trends in several countries of south Europe demonstrated that the helmet is the alternative first choice to delivering CPAP (Crimi et al., 2010).

show abstract

“…The use of a heated humidifier allows adequate humidification while avoiding condensation but does not affect patients’ level of comfort [ 88 ]; the humidifier should be adjusted at 26 °C with a temperature gradient that increases towards the patient (+ 2 °C) [ 89 ]. Others have suggested that the best comfort is obtained by humidifying without heating [ 90 ].…”

Section: Patient Comfort Complications and Other Practical Issuesmentioning

confidence: 99%

The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings

et al. 2021

View full text Add to dashboard Cite

A helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO2 rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.

show abstract

Influence of Humidification on Comfort During Noninvasive Ventilation With a Helmet

Abstract: With the clinical use of a helmet, for patient comfort and mucosal humidification during CPAP, the most desirable conditions are likely to be obtained by humidifying without heating, that is by leaving the water in the humidifier chamber at room temperature.

Cited by 18 publications

References 13 publications

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

How different helmet fixing options could affect patients' pain experience during helmet‐continuous positive airway pressure

The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings

Contact Info

Product

Resources

About