Utilización de la ventilación mecánica no invasiva en neumonía grave por virus H1N1

Muncharaz, A. Belenguer; Reig-Valero, R.; Altaba-Tena, Susana; Casero-Roig, Patricia; Ferrándiz-Sellés, Amparo

doi:10.1016/j.medin.2011.04.001

Cited by 42 publications

(16 citation statements)

References 19 publications

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“…Whether NIV delivered by helmet could reduce the intubation rate and mortality was still causing controversy [15, 16], furthermore, the effect on gas exchange was also confusing. Some studies indicated NIV delivered by helmet could improve oxygenation further compared with a face mask [17, 18], while others showed there was no significant difference in oxygenation [19–21], and some studies even demonstrated helmet-induced carbon dioxide rebreathing [22]. …”

Section: Introductionmentioning

confidence: 99%

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

et al. 2016

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BackgroundNoninvasive ventilation (NIV) has proved to be a useful technique for breathing support. However, complications, discomfort, and failure of NIV were commonly caused by the mask. Therefore, the helmet was developed to improve performance and reduce complications; however, there has been no conclusive results on its effect until now. Thus, we performed a systematic review and meta-analysis to investigate the effect of NIV with a helmet versus the control strategy in patients with acute respiratory failure (ARF).MethodsWe searched Cochrane Library, PubMed, Ovid, and Embase databases and bibliographies of relevant articles published before June 2016. Randomized and case-control studies that adopted the helmet as an NIV interface and compared it with another interface were included. The primary outcomes were hospital mortality, intubation rate, and complications. The secondary outcomes included the length of intensive care unit (ICU) stay, gas exchange, and respiratory rate. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated by the Mantel-Haenszel method and mean difference by the inverse variance method in a fixed effect model or random effects model according to the heterogeneity.ResultsA total of 11 studies involving 621 patients were included. The overall hospital mortality was 17.53 % in the helmet NIV group versus 30.67 % in the control group. Use of the helmet was associated with lower hospital mortality (OR 0.43, 95 % CI 0.26 to 0.69, p = 0.0005), intubation rate (OR 0.32, 95 % CI 0.21 to 0.47, P < 0.00001), and complications (OR 0.6, 95 % CI 0.4 to 0.92, P = 0.02). In contrast, there was no significant difference in gas exchange and ICU stay (P >0.05). Subgroup analysis found the helmet reduced mortality mainly in hypoxemic ARF patients (P < 0.05) and a lower intubation rate was shown in randomized trials; fewer complications caused by the helmet might be restricted to case-control trials. Additionally, the effect of the helmet on PaCO2 was influenced by type of ARF and ventilation mode (P <0.00001).ConclusionNIV with a helmet was associated with reduced hospital mortality and intubation requirement. The helmet was as effective as the mask in gas exchange with no additional advantage. Large randomized controlled trials are needed to provide more robust evidence.

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Section: Introductionmentioning

confidence: 99%

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

et al. 2016

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“…A retrospective observational study evaluated the use of NIV in all patients admitted to intensive care with presumed or confirmed influenza A (H1N1) infection and hypoxemic acute respiratory failure [49]. NIV was delivered as CPAP and PSV with a helmet or face mask.…”

Section: Resultsmentioning

confidence: 99%

“…The helmet presented similar oxygenation rates in eight [29,41,42,49,54,57-59] and similar intubation rates in four [32,42,57,59] of these compared to the face mask. The outcome was similar in six studies [32,42,54,57-59].…”

Section: Discussionmentioning

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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“…2 GTEI informative bulletin of the SEMICYUC reported that 80.3% (n = 237) of the patients required MV. 18 However, of the patients included in the registry of Belenguer et al 19 with P0 2 /Fi0 2 at admission, 87 presented parameters indicative of a good prognosis in the first hour, as defined in the literature. These subjects posteriorly required intubation [.…”

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confidence: 98%

Noninvasive ventilation in pneumonia due to N1H1 virus

Grande

2011

Medicina Intensiva (English Edition)

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Utilización de la ventilación mecánica no invasiva en neumonía grave por virus H1N1

Abstract: Based on our results, increased use of noninvasive mechanical ventilation in future epidemics coujld be proposed.

Cited by 42 publications

References 19 publications

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

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

Noninvasive ventilation in pneumonia due to N1H1 virus

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