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01-06-2011 | Physiological and Technical Notes

Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply

Authors: Manuela Milan, Alberto Zanella, Stefano Isgrò, Salua Abd El Aziz El Sayed Deab, Federico Magni, Antonio Pesenti, Nicolò Patroniti

Published in: Intensive Care Medicine | Issue 6/2011

Abstract

Purpose

We assessed the performance of different continuous positive airway pressure (CPAP) helmets equipped with a safety valve during discontinuation of fresh gas flow.

Methods

This was a physiological study of five healthy volunteers. We delivered CPAP (fresh gas flow 60 l/min, FiO₂ 60%, PEEP 5 cmH₂O) with three different helmets in a random sequence: 4Vent (Rüsch), HelmHAR-cp (Harol) and CaStar CP210 (StarMed). For each helmet we randomly applied, for up to 4 min, three disconnections of fresh gas flow: helmet inlet (D_inlet), flowmeter (D_flowmeter) and gas source (D_source). We continuously recorded from a nostril: end-tidal CO₂ (PetCO₂), inspiratory CO₂ (PiCO₂), fraction of inspired oxygen (FiO₂) and respiratory rate (RR).

Results

During every disconnection we observed an increase in PiCO₂ and PetCO₂ with a drop in FiO₂, while RR did not change. FiO₂ decreased more quickly in the CaStar, equipped with the largest safety valve, during D_source and D_flowmeter, while FiO₂ decreased more quickly during D_inlet in CaStar and in 4Vent. PiCO₂ resulted in a lower increase in CaStar during D_source and D_flowmeter compared to 4Vent. PetCO₂ in CaStar increases more slowly compared to 4Vent during D_source and more slowly compared to the other two helmets during D_flowmeter. During D_inlet similar degrees of CO₂ rebreathing and PetCO₂ were recorded among all the helmets.

Conclusions

To minimize CO₂ rebreathing during disconnection of the fresh gas supply while performing helmet CPAP, it is desirable to utilize large helmets with a large anti-suffocation valve. Monitoring and alarm systems should be employed for safe application of helmet CPAP.

International Consensus Conferences in Intensive Care Medicine (2001) Noninvasive positive pressure ventilation in acute Respiratory failure. Am J Respir Crit Care Med 163:283–291

Bellani G, Patroniti N, Greco M, Foti G, Pesenti A (2008) The use of helmets to deliver non-invasive continuous positive airway pressure in hypoxemic acute respiratory failure. Minerva Anestesiol 74:651–656PubMed

Taccone P, Hess D, Caironi P, Bigatello LM (2004) Continuous positive airway pressure delivered with a “helmet”: effects on carbon dioxide rebreathing. Crit Care Med 32:2090–2096PubMedCrossRef

Patroniti N, Foti G, Manfio A, Coppo A, Bellani G, Pesenti A (2003) Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study. Intensive Care Med 29:1680–1687PubMedCrossRef

Mojoli F, Iotti G, Gerletti M, Lucarini C, Braschi A (2008) Carbon dioxide rebreathing during non-invasive ventilation delivered by helmet: a bench study. Intensive Care Med 34:1454–1460PubMedCrossRef

Antonelli M, Pennisi MA, Montini L (2005) Clinical review: noninvasive ventilation in the clinical setting—experience from the past 10 years. Crit Care 9:98–103PubMedCrossRef

Principi T, Pantanetti S, Catani F, Elisei D, Gabbanelli V, Pelaia P, Leoni P (2004) Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med 30:147–150PubMedCrossRef

Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163:540–577PubMed

Tonnelier JM, Prat G, Nowak E, Goetghebeur D, Renault A, Boles JM, L’Her E (2003) Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study. Intensive Care Med 29:2077–2080PubMedCrossRef

10.

Patroniti N, Saini M, Zanella A, Isgro S, Pesenti A (2007) Danger of helmet continuous positive airway pressure during failure of fresh gas source supply. Intensive Care Med 33:153–157PubMedCrossRef

11.

Lofaso F, Brochard L, Hang T, Lorino H, Harf A, Isabey D (1996) Home versus intensive care pressure support devices. Experimental and clinical comparison. Am J Respir Crit Care Med 153:1591–1599PubMed

Title: Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply
Authors: Manuela Milan
Alberto Zanella
Stefano Isgrò
Salua Abd El Aziz El Sayed Deab
Federico Magni
Antonio Pesenti
Nicolò Patroniti
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 6/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2207-3

At a glance: The STEP trials

Springer Medicine

Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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