Feltracco P, Serra E, Barbieri S, Persona P, Rea F, Loy M, Ori C. Clin Transplant. 2009 Sep-Oct;23(5):748-50.
This case report described the clinical course of two patients that suffered from refractory hypoxemia caused by the post-reimplantation syndrome treated with NIV in the prone and Trendelenburg positions. The first case report was characterised by a 37-year old woman undergoing bilateral sequential single lung transplant (BSSLT), as a consequence of end stage respiratory failure. She was extubated a few hours after arriving to the ICU and subsequently developed extensive patchy alveolar consolidations in the dorsal and basal regions of the lungs. Due to unresponsive hypoxia, despite the treatment with high oxygen using a face mask, the patient was treated with NIV through respiratory helmet. This approach in conjunction with alternating between the prone and the Trendelenburg positions, improved the patient's condition. Moreover, the implanted lungs were better filled with air and further improvements of oxygenation allowed the removal of the helmet. In the second case, a 44-year-old man with cystic fibrosis underwent BSSLT due to end-stage respiratory failure. Several hours after arriving in the ICU the patient was extubated, but due to increased oxygen desaturation he was treated with facemask delivered NIV. His gas exchange deteriorated as a consequence of lung infiltrations and atelectasis of the lower lobes. Similar to the first case, the implementation of the mask NIV delivery and change in position lead to the improvement of the patient's condition. Therefore, the results from these two case studies show that the use of helmet or facemask NIV in conjunction with position changes represents a valuable approach in patients that have undergone lung transplantation.
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.
Qi Liu, Yonghua Gao, Rongchang Chen and Zhe Cheng. Crit Care. 2016;20(1):265
This meta-analysis aimed to analyse the effects of NIV using the helmet in comparison to a control strategy in patients with acute respiratory failure (ARF). Primary outcomes were hospital mortality, intubation rate and complications and secondary outcomes included length of intensive care unit (ICU) stay, gas exchange and respiratory rate. Results from 11 studies and 621 patients demonstrated that the overall mortality was circa 18% in the helmet NIV group versus circa 31% in the in the control group. The helmet implementation was also linked with lower hospital mortality, intubation and complication rates. Furthermore, subgroup analysis showed that the helmet reduced mortality mainly in hypoxemic ARF patients and the PaCO2 was influenced by the type of ARF and ventilation mode. Thus, the helmet represents a superior approach to the conventional therapy, but additional larger studies must be carried out to confirm these results.
Link to abstract.
Pelosi P, Severgnini P, Aspesi M, Gamberoni C, Chiumello D, Fachinetti C, Introzzi L, Antonelli M, Chiaranda M. Eur J Emerg Med. 2003 Jun;10(2):79-86.
Early review of the use of NIV and the helmet interface in the emergency department and in the pre-hospital setting. Authors concluded that the helmet 'can extend the application of non-invasive positive pressure ventilation in different categories of patients with respiratory failure'.
Link to abstract.