An important aspect that can influence the efficacy of NIV is the choice of interface(nasal, oronasal, nasal pillows); sometimes the interface can be not tolerated (facial skill lesion, ocular and nasal irritation) or ineffective (mouth leak, difficult to fit the mask, bad setting of ventilator). A relatively new NPPV interface is the helmet: some studies demonstrated the efficacy of helmet, in CPAP or NPPV, to treat Acute Respiratory Failure (ARF)(Antonelli M. et al. Anesthesiology 2004;100–1:16–24).Aim of this study was to evaluate the effectiveness of helmet NIV in patients admitted to our Respiratory Intensive Care Unit (RICU), in whom mask ventilation failed due to ineffectiveness or intolerance.
We selected 31 consecutive patients (21 M e 10F), suffering from ARF, admitted to our RICU during last two years, who failed an attempt of NIV with facial mask. We excluded pts with hypercapnic encephalopathy, GCS <9, haemodynamic instability, cardiogenic or septic shock. Patients underwent measurements of ABG analysis, RR, hearth rate (HR), BP at baseline (during oxygen therapy) and after 1 h,12 h of helmet ventilation and when clinically required.Satisfaction of patients for helmet use were registered.
Patients’ characteristics are showed in table 1. ABG analysis at 1 h and 12 h of helmet ventilation shows a significant improvement of paO2 in the majority of patients, instead there was no significant variation of pCO2 values. The intubation rate was low. The tolerability for helmet ventilation was very good.
In this group of patients, Helmet ventilation improved significantly ABG analysis and reduced the need on invasive treatment. The helmet ventilation seems less effective to improve carbon dioxide elimination.
Prolonged mask ventilation, especially with continuosly application, can induce facial lesion with ventilation interruption and intolerance. Helmet can be an alternative to NPPV by facial mask in the treatment of patients suffering from ARF, improving ABG values and reducing the need of invasive ventilation. Other studies should be performed to evaluated effectiveness of helmet ventilation in hypercapnic respiratory failure.
Stefano Baglioni, No Financial Disclosure Information; No Product/Research Disclosure Information