“…2 , positive pressure not only improved oxygenation but also allowed better stratification of patient severity [ 40 ]. Some authors also suggested that an incremental PEEP trial might allow a PEEP selection with optimized oxygenation while avoiding haemodynamic complications [ 41 ]. Fig.…”
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.
“…2 , positive pressure not only improved oxygenation but also allowed better stratification of patient severity [ 40 ]. Some authors also suggested that an incremental PEEP trial might allow a PEEP selection with optimized oxygenation while avoiding haemodynamic complications [ 41 ]. Fig.…”
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.
“…Absent space to provide details, we also take issue with the following items: Authors did not consider the relevant BeS studies of beryllium miners, 2 gem cutters, 3 the general population, 4 and studies of the accuracy of the BeLPT. 5,6 The use of three of five downwind cases as "evidence" is speculative, absent upwind/downwind air samples.…”
“…Equivalence of both tests has been demonstrated 1 ; the method has been used by us and others. [2][3][4] Additionally, we addressed the use of 5bromo-2ʹ-deoxyuridine as caveat in our article. The authors also criticize that the use of mean AE 3SD is "a highly conservative cut off."…”
“…Recent data documented a successful lung recruitability test in fewer than 30% of COVID-19 patients undergoing CPAP, and these tests also should be considered in clinical practice in patients undergoing prone and lateral positioning to document safety and efficacy of this intervention. 4 Third, the management of the interface, either facemask or helmet, during NIV/ CPAP should be optimized during prone and lateral chestjournal.org positioning, as anticipated by Dr Fiorentino and coworkers. A 180-degree rotation of the helmet during CPAP/NIV treatment is crucial to have the safety (antiasphyxia) valve free from any possible obstruction.…”
Section: Responsementioning
confidence: 99%
“…Authors did not consider the relevant BeS studies of beryllium miners, 2 gem cutters, 3 the general population, 4 and studies of the accuracy of the BeLPT. 5,6 The use of three of five downwind cases as "evidence" is speculative, absent upwind/downwind air samples.…”
In fact, in the pattern ground-glass opacification/opacity, the response is very quickly correlated with _ V/ _ Q matching or edema formation. Still, this benefit should disappear immediately when the patient is repositioned in the supine position, as shown in Retucci et al's work. 1 Rather than improvements in _ V/ _ Q matching, no variation of the lung ultrasound pattern before and after prone noninvasive ventilation has been detected in the study. 2 In the consolidative pattern, the response is unpredictable, especially if the thickened areas are peripheral and posterior. The pronation may interrupt the process of progressive basilar atelectasis and rapid deterioration. 3 However, this could be challenging in COVID-19 patients with obesity. An approach to overcome this issue is a pregnancy massage pillow, which is essentially an inflatable pillow with a cut-out to allow for a protuberant abdomen. In the prone position, this support allows release of abdominal pressure on the chest.Another clinical problem is the patient's prone position compliance and interface use. The helmet is the most advantageous and safest interface to give a CPAP, but it is difficult to use in prone patients. 3 The most likely complications caused by prone positioning (eg, vomiting or nausea in patients with pancreatic or abdominal problems in general) would have been clinically evident. In the last period, during low-pressure CPAP use, there is a lot of pneumomediastinum and pneumothorax incidence. It is a real problem for the change of position and prone position, especially during nondrained pneumomediastinum and the placement of any drainages in patients who would require the prone position should be carefully evaluated.
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