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Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF): Is the helmet an effective interface? A pilot RCT

Chiara Mega, Lara Pisani, Paolo Navalesi, Andrea Bellone, Raffaele Scala, Vanessa Repetto, Corrado Zenesini, Luca Fasano, Manuela Del Forno, Stefano Nava
European Respiratory Journal 2012 40: P2025; DOI:
Chiara Mega
1Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Lara Pisani
1Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Paolo Navalesi
2Medicina Traslazionale, Università Piemonte Orientale, Novara, Italy
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Andrea Bellone
3Emergency Department, A.O Sant'Anna, Como, Italy
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Raffaele Scala
4Respiratory Unit, San Donato Hospital, Arezzo, Italy
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Vanessa Repetto
2Medicina Traslazionale, Università Piemonte Orientale, Novara, Italy
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Corrado Zenesini
5Dipartimento Sanità Pubblica, AUSL Bologna, Area Epidemiologia, Bologna, Italy
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Luca Fasano
1Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Manuela Del Forno
1Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Stefano Nava
1Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Abstract

To date the helmet is rarely used in AHRF, despite in hypoxic respiratory failure, it is employed as a “rotating” strategy when the facial mask is poorly tolerated.

In a multicenter RCT, we compared the clinical efficacy of a new helmet designed to specifically improve the performance in COPD vs a full face mask during an episode of AHRF.

17 COPDs with AHRF were randomly assigned to receive NIV either with full face mask (GroupA,n=9pH=7,26±0.07PaCO2=73.7±10.8mmHg,PaO2/FiO2=97.3±53.7) or the helmet (GroupB,n=8pH=7.24±0.05PaCO2=83.3±14.2mmHg,PaO2/FiO2=100.6±41).In the former group the ventilator settings were decided according to the usual practice (i.e. the maximal inspiratory pressure tolerated and CPAP=4cmH20),while in latter group according to published data(Crit Care Med 2009; 37:1921).

ABGs were evaluated at admission,1 and 6 hour and then everyday until discharge. Vital parameters, discomfort scale, dyspnea score and adverse events were recorded.

Baseline characteristics did not differ significantly between the two groups. 2 and 1 patients for groupA and B respectively required intubation. NIV improved gas exchange vs baseline (p< 0.05) both with mask and helmet (pHA=7,34±0.08PaCO2A=59.7±12.3mmHg, and pHB=7,30±0.06PaCO2B=70.4±13.8mmHg, at 1h; and pHA=7,39±0.07,PaCO2A=55.2±11.2mmHg, pHB=7,39±0.04,PaCO2B=58.0±6.0mmHg, at 6 h). No differences in vital signs, patients' comfort and dyspnea score were observed between the two groups.

In conclusion in this pilot RCT we have shown that the helmet may be a valid alternative to the “classical” full face mask during an episode of AHRF, making the former interface possible alternative for “rotating” strategy.

  • Acute respiratory failure
  • COPD - exacerbations
  • Critically ill patients
  • © 2012 ERS
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Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF): Is the helmet an effective interface? A pilot RCT
Chiara Mega, Lara Pisani, Paolo Navalesi, Andrea Bellone, Raffaele Scala, Vanessa Repetto, Corrado Zenesini, Luca Fasano, Manuela Del Forno, Stefano Nava
European Respiratory Journal Sep 2012, 40 (Suppl 56) P2025;

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Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF): Is the helmet an effective interface? A pilot RCT
Chiara Mega, Lara Pisani, Paolo Navalesi, Andrea Bellone, Raffaele Scala, Vanessa Repetto, Corrado Zenesini, Luca Fasano, Manuela Del Forno, Stefano Nava
European Respiratory Journal Sep 2012, 40 (Suppl 56) P2025;
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