JOURNAL CLUB: Helmet noninvasive support in hypoxemic respiratory failure
By: Marcelo Alcantara, Médico - 06/21/2022 19:03
Recently, there has been renewed interest in using noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP) delivered through the helmet interface.
This interface has many advantages over other types:
-Better comfort favoring prolonged continuous use
-Possibility of applying higher PEEP levels
-Avoidance of air leaks and ambient and personal contamination through patient droplets.
-Potential of mitigating patient-self inflicted lung injury (P-SILI)
-Reduction of transpulmonary driving pressure
In this opinion paper, experts in the field, Drs Domenico L Grieco and Massimo Antonelli fromFondazione Policlinico Universitario A. Gemelli, Rome, Italy and Dr Bhakti K Patel, from Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, USA comments on physiological, clinical, pragmatical and potential aspects of helmet-based ventilatory support.
Two main possibilities for using it exist: HELMET-NIV and HELMET-CPAP, as shown in the figure:
No studies have compared them face to face.
However, they make interesting suggestions on how to use it in both setups.
Find the full paper in the link below.
In Brazil, a new helmet-CPAP interface has been developed in Ceará state, changing how COVID-19 patients were treated during the pandemic.
Find the ELMO experience (ELMO means "A War Helmet" in Portuguese)
Check the feasibility paper and the dedicated site below
Tomaz BS, Gomes GC, Lino JA, Menezes DGA, Soares JB, Furtado V, et al. ELMO, a new helmet interface for CPAP to treat COVID-19-related acute hypoxemic respiratory failure outside the ICU: a feasibility study. J Bras Pneumol. 2022;48(1):e20210349
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