Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Eur Respir Rev. 2020 Apr 3;29(155):200068
The objective of this paper is to provide evidence-based recommendations for the correct use of respiratory devices in the COVID-19 emergency and protect healthcare workers from contracting the SARS-CoV-2 infection. Current evidence shows that around 20% of COVID-19 patients develop a severe Respiratory Distress Syndrome, which in almost a third of the cases requires respiratory support treatment. This type of support includes the use of oxygen therapy, HFNC, CPAP and NIV, which are non-invasive methods with a high risk of aerosol dispersion, especially in unprotected environments. Amongst those methods of delivery of non-invasive respiratory support, the use of a respiratory helmet with an inflatable neck cushion represents the safest option. In addition, data suggest that respecting the indications for the use of PPE is effective in preventing infections among healthcare workers, as demonstrated in a case–control study conducted during the SARS epidemic in Hong Kong. This study investigated the effective adhesion of personnel to PPE (gloves, disposable shirts, goggles and masks) and reported that none of the staff using all the safety measures contracted the virus, while all the infected staff had omitted at least one of them. Therefore, the helmet with neck cushion to treat infected patients with severe respiratory distress syndrome and PPE measures by the personnel must be adopted to prevent the spreading of infection amongst other patients and medical personnel.
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Brambilla AM, Aliberti S, Prina E, Nicoli F, Forno MD, Nava S, Ferrari G, Corradi F, Pelosi P, Bignamini A, Tarsia P, Cosentini R. Intensive Care Med. 2014 Jul;40(7):942-9
Multi-centre, randomised controlled trial across four Italian centres. Patients split into helmet CPAP and Venturi mask groups. Primary end point was percentage of patients meeting criteria for ETI. Authors conclude helmet CPAP reduces the risk of meeting ETI criteria in this scenario.
Link to abstract.
Cosentini R, Brambilla AM, Aliberti S, Bignamini A, Nava S, Maffei A, Martinotti R, Tarsia P, Monzani V, Pelosi P.
Chest. 2010 Jul;138(1):114-20
Multi-centre, randomised controlled trial. 47 patients admitted to ED with moderate hypoxemic acute respiratory failure (ARF) due to community-acquired pneumonia (CAP) were split into helmet CPAP or standard oxygen therapy groups. Primary end point was time to reach PaO2/FiO2 ratio > 315. The proportion of patients who reached the primary end point was also recorded. Authors conclude that CPAP delivered by helmet rapidly improves oxygenation in this scenario.
Link to abstract.
Masip J, Roque M, Sánchez B, Fernández R, Subirana M, Expósito JA. JAMA. 2005 Dec 28;294(24):3124-30
Meta-analysis of 15 relevant randomised controlled trials and systematic reviews comparing NIV to conventional oxygen therapy in patients with acute pulmonary edema. Authors conclude that NIV 'reduces the need for intubation and mortality' in this scenario.
Link to abstract.