RT Journal Article
SR Electronic
T1 Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF): Is the helmet an effective interface? A pilot RCT
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2025
VO 40
IS Suppl 56
A1 Chiara Mega
A1 Lara Pisani
A1 Paolo Navalesi
A1 Andrea Bellone
A1 Raffaele Scala
A1 Vanessa Repetto
A1 Corrado Zenesini
A1 Luca Fasano
A1 Manuela Del Forno
A1 Stefano Nava
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P2025.abstract
AB 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.