Radovanovic D, Rizzi M, Pini S, Saad M, Chiumello DA, Santus P. J Clin Med. 2020;9(4):1191
The author of this research study proposes a management strategy for the treatment of acute hypoxemic respiratory failure in patients with COVID-19. Respiratory support with NIV or high flow oxygen should be avoided to limit droplets/virus aerosolisation and healthcare worker contamination. Therefore, the implementation of CPAP through a helmet system may provide an effective and safer alternative to improve hypoxemia. In addition, the use of the helmet will also reduce room contamination and improve patient comfort, while guaranteeing better clinical assistance and long term tolerability. However, careful CPAP titration must be provided to better optimise the recruitment of unventilated lung sections to improve patient outcomes.
Lucchini A, Giani M, Isgrò S, Rona R, Foti G. Intensive Crit Care Nurs. 2020;58:102859
The COVID-19 outbreak represents a new challenge for intensive care teams, and of particular importance is the limitation of virus aerosolisation during intubation, bronchoscopy and non-invasive ventilation. As a result, the use of helmet ventilation has been suggested for CPAP and pressure support ventilation to reduce the spread of the virus. This letter suggests a helmet CPAP bundle to improve the patient’s comfort during extended applications by reducing the noise with an HME filter, using counterweights attached to armpit straps to avoid discomfort , as well as implementing active humidification.
Link to abstract.
Cammarota G, Longhini F, Perucca R, Ronco C, Colombo D, Messina A, Vaschetto R, Navalesi P.
Anesthesiology. 2016 Dec;125(6):1181-1189
Randomised trial of 15 patients undergoing three 30-minutes ventilation trials using two different helmets. The ventiltion modes were randomly applied: pneumatically triggered pressure support ventilation (PSP), neurally adjusted ventilatory assist (NAVA) and neurally controlled pressure support (PSN). The latter is a new proposed setting of the NAVA mode. Authors conclude that PSN improves comfort and patient-ventilator interactions in this scenario.
Link to abstract.
Yuwen Luo, Yan Luo, Yun Li, Luqian Zhou, Zhe Zhu, Yitai Chen, Yuxia Huang, and Xin Chen. Yonsei Med J. 2016 Jul 1; 57(4): 936–941.
This meta-analysis aimed to investigate the effects of helmet CPAP on gas exchange, mortality, intubation rate and in-hospital mortality rate in comparison with the conventional oxygen therapy (COT). Data obtained from four studies and 377 subjects with hypoxemic acute respiratory failure (hARF) showed that helmet CPAP significantly increased the PaO2/FiO2, and reduced the arterial carbon dioxide levels, intubation rate and in-hospital mortality rates as compared to COT therapy. These results suggest that the helmet improves oxygenation, reduces mortality and intubation rates. However, large randomised controlled trials are needed to validate these findings.
Link to abstract.
Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. JAMA. 2016 Jun 14;315(22):2435-41
Single-centre randomised trial of 83 patients to determine whether NIV through helmet improves intubation rate among patients with ARDS. Primary outcome was proportion of patients who needed ETI, secondary outcomes included 28-day invasive ventilator-free days, ICU length of stay, and 90-day mortality. Authors conclude helmet NIV treatment resulted in a significant reduction of intubation rates as well as statistically significant reduction in 90-day mortality.
Link to abstract.