Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply

Milan, Manuela; Zanella, Alberto; Isgrò, Stefano; Deab, Salua Abd El Aziz El Sayed; Magni, Federico; Pesenti, Antonio; Patroniti, Nicolò

doi:10.1007/s00134-011-2207-3

Cited by 16 publications

(16 citation statements)

References 10 publications

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“…The presence of an antisuffocation valve ( Figure S1) limits the CO 2 rebreathing, but cannot prevent the loss of PEEP in case of gas flow interruption [22]. In this case, the adoption of larger valves allows for a lower CO 2 rebreathing, but also a higher reduction in FiO 2 [25]. When CPAP is administered by means of mechanical ventilators, it is generally not advisable to use the helmet [8,22] because the higher compliance of the helmet may cause a delay between the delivered inspiratory flow and patients' inspiratory effort, which can cause patient-ventilatory asynchrony.…”

Section: Cpap Side Effects and Helmet Pitfallsmentioning

confidence: 99%

Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

Radovanovic

Rizzi

Pini

et al. 2020

JCM

121

123

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Since the beginning of March 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused more than 13,000 deaths in Europe, almost 54% of which has occurred in Italy. The Italian healthcare system is experiencing a stressful burden, especially in terms of intensive care assistance. In fact, the main clinical manifestation of COVID-19 patients is represented by an acute hypoxic respiratory failure secondary to bilateral pulmonary infiltrates, that in many cases, results in an acute respiratory distress syndrome and requires an invasive ventilator support. A precocious respiratory support with non-invasive ventilation or high flow oxygen should be avoided to limit the droplets' air-dispersion and the healthcare workers' contamination. The application of a continuous positive airway pressure (CPAP) by means of a helmet can represent an effective alternative to recruit diseased alveolar units and improve hypoxemia. It can also limit the room contamination, improve comfort for the patients, and allow for better clinical assistance with long-term tolerability. However, the initiation of a CPAP is not free from pitfalls. It requires a careful titration and monitoring to avoid a delayed intubation. Here, we discuss the rationale and some important considerations about timing, criteria, and monitoring requirements for patients with COVID-19 respiratory failure requiring a CPAP treatment.

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Section: Cpap Side Effects and Helmet Pitfallsmentioning

confidence: 99%

Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

Radovanovic

Rizzi

Pini

et al. 2020

JCM

121

123

View full text Add to dashboard Cite

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“…An antisuffocation valve, which allows room air to enter the helmet during any interruption of gas flow, limited the CO 2 rebreathing but not the loss of external PEEP [9]. In a subsequent study, Milan and colleagues [10], testing three commercially available helmets supplied with antisuffocation valves, found that the helmet with the largest valve had lower CO 2 rebreathing but a greater reduction in oxygenation in case of interruption of the gas flow.…”

Section: Resultsmentioning

confidence: 99%

Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

et al. 2013

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Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO2 rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure.

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“…Anything that increases helmet ventilation (i.e., air leak and delivery of fresh gas) may decrease the inspired partial pressure of CO 2 . An anti-suffocation valve, a safety valve that allows air to enter into the helmet during any interruption of gas flow, may limit CO 2 rebreathing [144-146].…”

Section: Dead Space Interface Volume and “Vented And Non-vented Mask”mentioning

confidence: 99%

Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation – A Concise Review

et al. 2020

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Non-invasive ventilation (NIV) has dramatically changed the treatment of both acute and chronic respiratory failure in the last 2 decades. The success of NIV is correlated to the application of the “best ingredients” of a patient’s “tailored recipe,” including the appropriate choice of the selected candidate, the ventilator setting, the interface, the expertise of the team, and the education of the caregiver. The choice of the interface is crucial for the success of NIV. Type (oral, nasal, nasal pillows, oronasal, hybrid mask, helmet), size, design, material and headgears may affect the patient’s comfort with respect to many aspects, such as air leaks, claustrophobia, skin erythema, eye irritation, skin breakdown, and facial deformity in children. Companies are paying great attention to mask development, in terms of shape, materials, comfort, and leak reduction. Although the continuous development of new products has increased the availability of interfaces and the chance to meet different requirements, in patients necessitating several daily hours of NIV, both in acute and in chronic home setting, the rotational use of different interfaces may remain an excellent strategy to decrease the risk of skin breakdown and to improve patient’s tolerance. The aim of the present review was to give the readers a background on mask technology and materials in order to enhance their “knowledge” in making the right choice for the interface to apply during NIV in the different clinical scenarios.

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Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply

Abstract: To minimize CO(2) rebreathing during disconnection of the fresh gas supply while performing helmet CPAP, it is desirable to utilize large helmets with a large anti-suffocation valve. Monitoring and alarm systems should be employed for safe application of helmet CPAP.

Cited by 16 publications

References 10 publications

Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation – A Concise Review

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