Longhini F, Bruni A, Garofalo E, et al. Pulmonology. 2020;26(4):186-191
This study set out to investigate the safety and efficacy of combining helmet CPAP (hCPAP) and prone position in order to avoid deterioration of gas exchange and intubation in patients with COVID-19 induced pneumonia. Preliminary results from an ongoing study in COVID-19 patients, measuring tidal volume during hCPAP, showed a low mean tidal volume, high pulmonary compliance and low respiratory rate, which translates in a low transpulmonary pressure. At this stage the real effects and efficacy of hCPAP from the pathophysiological stand point is not known. In healthy patients, findings suggest that redistribution of perfusion could improve oxygenation in patients lacking hypoxic vasoconstriction. If the hypothesis presented in this study is confirmed, this may reduce the requirement for endotracheal intubation, invasive mechanical ventilation, hospital length of stay and improving the survival rates. Moreover, it could also reduce the need for ICU beds, which can be substituted by sub-intensive beds.
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