Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask

Navalesi, Paolo; Costa, Roberta; Ceriana, Piero; Carlucci, Annalisa; Prinianakis, George; Antonelli, Massimo; Conti, Giorgio; Nava, Stefano

doi:10.1007/s00134-006-0391-3

Cited by 129 publications

(103 citation statements)

References 38 publications

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“…In accordance with previous studies, 12,13,[16][17][18] our results showed that the helmet does not perform as well as the face mask or ETT. Racca et al 19 demonstrated in 6 healthy volunteers that PSV delivered by a helmet was less effective in unloading the work of breathing compared with a face mask using the same level of support.…”

Section: Discussionsupporting

confidence: 92%

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

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BACKGROUND: In adults and children, patient-ventilator synchrony is strongly dependent on both the ventilator settings and interface used in applying positive pressure to the airway. The aim of this bench study was to determine whether different interfaces and ventilator settings may influence patient-ventilator interaction in pediatric models of normal and mixed obstructive and restrictive respiratory conditions. METHODS: A test lung, connected to a pediatric mannequin using different interfaces (endotracheal tube [ETT], face mask, and helmet), was ventilated in pressure support ventilation mode testing 2 ventilator settings (pressurization time [Time press ] 50% /cycling-off flow threshold [Tr exp ] 25% , Time press80% /Tr exp60% ), randomly applied. The test lung was set to simulate one pediatric patient with a healthy respiratory system and another with a mixed obstructive and restricted respiratory condition, at different breathing frequencies (f) (30, 40, and 50 breaths/min). We measured inspiratory trigger delay, pressurization time, expiratory trigger delay, and time of synchrony. RESULTS: At each breathing frequency, the helmet showed the longest inspiratory trigger delay compared with the ETT and face mask. At f 30 , the ETT had a reduced T press . The helmet had the shortest T press in the simulated child with a mixed obstructive and restricted respiratory condition, at f 40 during Time press50% /Tr exp25% and at f 50 during Time press80% /Tr exp60% . In the simulated child with a normal respiratory condition, the ETT presented the shortest T press value at f 50 during Time press80% /Tr exp60% . Concerning the expiratory trigger delay, the helmet showed the best interaction at f 30 , but the worst at f 40 and at f 50 . The helmet showed the shortest time of synchrony during all ventilator settings. CONCLUSIONS: The choice of the interface can influence patient-ventilator synchrony in a pediatric model breathing at increased f, thus making it more difficult to set the ventilator, particularly during noninvasive ventilation. The helmet demonstrated the worst interaction, suggesting that the face mask should be considered as the first choice for delivering noninvasive ventilation in a pediatric model.

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Section: Discussionsupporting

confidence: 92%

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Conti

Gregoretti²,

Spinazzola

et al. 2015

Respir Care

View full text Add to dashboard Cite

show abstract

“…We observed non-supported inspiration only in high pressure support via face mask because triggering was difficult due to high PEEPi. 23,24,[26][27][28] By increasing cycling to 40%, non-supported inspiration could completely be avoided due to its effect on expiratory cycle latency. Due to impaired flow and pressure transmission, much longer inspiration time was necessary in the helmet to trigger a ventilator breath.…”

Section: Discussionmentioning

confidence: 99%

“…Without leakage we did not find any wasted efforts with the helmet and only very few occasions with the mask, whereas others observed increased non-supported inspirations. 18,19,23,26 This difference might be explained by a difference in PEEP, which affects pressure transmission and trigger sensitivity, inspiratory force, and the performance of the ventilator.…”

Section: Discussionmentioning

confidence: 99%

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

et al. 2015

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BACKGROUND: During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction. METHODS: A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H 2 O) using the ventilator's invasive and NIV mode with and without an applied leakage. RESULTS: Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001). CONCLUSION: Augmenting the cycling criterion above the default setting (20 -30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered.

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“…It has been reported that NIV delivered via helmet is less efficient than via face mask in reducing inspiratory effort SEE THE ORIGINAL STUDY ON PAGE 15 and worsens patient-ventilator synchrony. [15][16][17][18][19] There has also been concern about CO 2 rebreathing with inspired P CO 2 being dictated by the amount of CO 2 produced by the subject and the amount of fresh gas flow flushing the large dead space in the helmet. 20,21 Higher flow in the helmet is required to overcome this, which may reduce patient comfort 22 The presence of rebreathing may create asynchrony by causing dyspnea and increased respiratory drive.…”

Section: Waiting To Exhale: Optimizing Noninvasive Synchrony In Copd?mentioning

confidence: 99%

Waiting to Exhale: Optimizing Noninvasive Synchrony in COPD?

Rettig

2015

Respir Care

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Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask

Abstract: Helmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort. The helmet, however, was less efficient in decreasing inspiratory effort and worsened the patient-ventilator interaction.

Cited by 129 publications

References 38 publications

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Influence of Different Interfaces on Synchrony During Pressure Support Ventilation in a Pediatric Setting: A Bench Study

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

Waiting to Exhale: Optimizing Noninvasive Synchrony in COPD?

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