Park MH, Kim MJ, Kim AJ, Lee MJ, Kim JS. World J Clin Cases. 2020;8(10):1939-1943.
This report described a case of a 73-year-old man with COPD (stage 4) admitted to the ICU with complaints of cough, sputum, and dyspnoea. The patient was previously treated with oxygen at home for 10 months during the day time and oronasal mask-based NIV during night time. At the time of admission, the infection was detected and infiltration was also present. He was subsequently diagnosed with AECOPD by community-acquired pneumonia. Conditions deteriorated and invasive ventilation became unavoidable. However, helmet-based NIV was chosen as the patient refused to proceed with the invasive procedure. After three days of helmet NIV, he regained consciousness and hypercapnia recovered to pre-hospitalisation levels. This report demonstrates that helmet-based NIV may be a crucial treatment strategy used to treat patients with AECOPD that refuse invasive approaches and oronasal mask-based NIV is non-effective.
Link to abstract.
Longhini F, Liu L, Pan C, et al. Respir Care. 2019;64(5):582-589
In this study compared neurally-controlled pressure support through a helmet with pressure support through a face mask for subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patient-ventilator synchrony. Two 30-min trials of NIV were randomly delivered to 10 subjects with COPD exacerbation. The first group was treated with pressure support through a face mask and the second group with NAVA through a helmet. Several parameters were evaluated including subject comfort, breathing frequency, respiratory drive, arterial blood gases, pressure-time product (PTP) of the first 300 ms and 500ms after initiation of subject effort, inspiratory trigger delay, and rate of asynchrony determined as the asynchrony index. NAVA through a helmet significantly improved comfort compared with pressure support through a face mask. Although the breathing pattern was not different between the methods, the respiratory drive was slightly reduced during NAVA through a helmet in comparison with pressure support through a face mask. Gas exchange was also not different between the trials. The PTP was comparable between trials, whereas triggering performance, patient-ventilator interaction, and synchrony were all improved by NAVA through a helmet compared with pressure support through a face mask. Therefore, in subjects with COPD with exacerbation, NAVA through a helmet improved comfort, triggering performance, and patient-ventilator synchrony compared with pressure support through a face mask.
Link to abstract
Antonelli M, Pennisi MA, Pelosi P, Gregoretti C, Squadrone V, Rocco M, Cecchini L, Chiumello D, Severgnini P, Proietti R, Navalesi P, Conti G. Anesthesiology. 2004 Jan;100(1):16-24
Study of 33 patients with COPD treated with helmet NPPV, compared with 33 historical controls treated with face mask NPPV. In the helmet group, no patients were unable to tolerate NPPV, whereas five of the control group required intubation. Authors conclude that helmet NPPV 'can be used to treat chronic COPD with acute exacerbation'.
Link to abstract.