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Open Access 01-12-2022 | Review

Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application

Authors: Melania Cesarano, Domenico Luca Grieco, Teresa Michi, Laveena Munshi, Luca S. Menga, Luca Delle Cese, Ersilia Ruggiero, Tommaso Rosà, Daniele Natalini, Michael C. Sklar, Salvatore L. Cutuli, Filippo Bongiovanni, Gennaro De Pascale, Bruno L. Ferreyro, Ewan C. Goligher, Massimo Antonelli

Published in: Annals of Intensive Care | Issue 1/2022

Abstract

Introduction

Helmet noninvasive support may provide advantages over other noninvasive oxygenation strategies in the management of acute hypoxemic respiratory failure. In this narrative review based on a systematic search of the literature, we summarize the rationale, mechanism of action and technicalities for helmet support in hypoxemic patients.

Main results

In hypoxemic patients, helmet can facilitate noninvasive application of continuous positive-airway pressure or pressure-support ventilation via a hood interface that seals at the neck and is secured by straps under the arms. Helmet use requires specific settings. Continuous positive-airway pressure is delivered through a high-flow generator or a Venturi system connected to the inspiratory port of the interface, and a positive end-expiratory pressure valve place at the expiratory port of the helmet; alternatively, pressure-support ventilation is delivered by connecting the helmet to a mechanical ventilator through a bi-tube circuit. The helmet interface allows continuous treatments with high positive end-expiratory pressure with good patient comfort. Preliminary data suggest that helmet noninvasive ventilation (NIV) may provide physiological benefits compared to other noninvasive oxygenation strategies (conventional oxygen, facemask NIV, high-flow nasal oxygen) in non-hypercapnic patients with moderate-to-severe hypoxemia (PaO₂/FiO₂ ≤ 200 mmHg), possibly because higher positive end-expiratory pressure (10–15 cmH₂O) can be applied for prolonged periods with good tolerability. This improves oxygenation, limits ventilator inhomogeneities, and may attenuate the potential harm of lung and diaphragm injury caused by vigorous inspiratory effort. The potential superiority of helmet support for reducing the risk of intubation has been hypothesized in small, pilot randomized trials and in a network metanalysis.

Conclusions

Helmet noninvasive support represents a promising tool for the initial management of patients with severe hypoxemic respiratory failure. Currently, the lack of confidence with this and technique and the absence of conclusive data regarding its efficacy render helmet use limited to specific settings, with expert and trained personnel. As per other noninvasive oxygenation strategies, careful clinical and physiological monitoring during the treatment is essential to early identify treatment failure and avoid delays in intubation.

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Title: Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application
Authors: Melania Cesarano
Domenico Luca Grieco
Teresa Michi
Laveena Munshi
Luca S. Menga
Luca Delle Cese
Ersilia Ruggiero
Tommaso Rosà
Daniele Natalini
Michael C. Sklar
Salvatore L. Cutuli
Filippo Bongiovanni
Gennaro De Pascale
Bruno L. Ferreyro
Ewan C. Goligher
Massimo Antonelli
Publication date: 01-12-2022
Publisher: Springer International Publishing
Published in: Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-022-01069-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application

Abstract

Introduction

Main results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Main results

Conclusions

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