Top

Intensive Care Medicine

Published in:

01-01-2013 | Original

An optimized set-up for helmet noninvasive ventilation improves pressure support delivery and patient–ventilator interaction

Authors: Francesco Mojoli, Giorgio A. Iotti, Ilaria Currò, Marco Pozzi, Gabriele Via, Aaron Venti, Antonio Braschi

Published in: Intensive Care Medicine | Issue 1/2013

Abstract

Objective

To test the effects on mechanical performance of helmet noninvasive ventilation (NIV) of an optimized set-up concerning the ventilator settings, the ventilator circuit and the helmet itself.

Subjects and methods

In a bench study, helmet NIV was applied to a physical model. Pressurization and depressurization rates and minute ventilation (MV) were measured under 24 conditions including pressure support of 10 or 20 cmH₂O, positive end expiratory pressure (PEEP) of 5 or 10 cmH₂O, ventilator circuit with “high”, “intermediate” or “low” resistance, and cushion deflated or inflated. In a clinical study pressurization and depressurization rates, MV and patient–ventilator interactions were compared in six patients with acute respiratory failure during conventional versus an “optimized” set-up (PEEP increased to 10 cmH₂O, low resistance circuit and cushion inflated).

Results

In the bench study, all adjustments simultaneously applied (increased PEEP, inflated cushion and low resistance circuit) increased pressurization rate (46.7 ± 2.8 vs. 28.3 ± 0.6 %, p < 0.05), depressurization rate (82.9 ± 1.9 vs. 59.8 ± 1.1 %, p ≤ 0.05) and patient MV (8.5 ± 3.2 vs. 7.4 ± 2.8 l/min, p < 0.05), and decreased leaks (17.4 ± 6.0 vs. 33.6 ± 6.0 %, p < 0.05) compared to the basal set-up. In the clinical study, the optimized set-up increased pressurization rate (51.0 ± 3.5 vs. 30.8 ± 6.9 %, p < 0.002), depressurization rate (48.2 ± 3.3 vs. 34.2 ± 4.6 %, p < 0.0001) and total MV (27.7 ± 7.0 vs. 24.6 ± 6.9 l/min, p < 0.02), and decreased ineffective efforts (3.5 ± 5.4 vs. 20.3 ± 12.4 %, p < 0.0001) and inspiratory delay (243 ± 109 vs. 461 ± 181 ms, p < 0.005).

Conclusions

An optimized set-up for helmet NIV that limits device compliance and ventilator circuit resistance as much as possible is highly effective in improving pressure support delivery and patient–ventilator interaction.

Villa F, Cereda M, Colombo E, Berra L, Nacoti M, Foti G, Pesenti A (1999) Evaluation of four non invasive CPAP systems. Intensive Care Med S 66:A246

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

Antonelli M, Conti G, Pelosi P, Gregoretti C, Pennisi MA, Costa R, Severgnini P, Chiaranda M, Proietti R (2002) New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet. A pilot controlled trial. Crit Care Med 30:602–608PubMedCrossRef

Antonelli M, Pennisi MA, Pelosi P, Gregoretti C, Squadrone V, Rocco M, Cecchini L, Chiumello D, Severgnini P, Proietti R, Navalesi P, Conti G (2004) Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease. A feasibility study. Anesthesiology 100:16–24PubMedCrossRef

Rocco M, Dell’Utri D, Morelli A, Spadetta G, Conti G, Antonelli M, Pietropaoli P (2004) Noninvasive ventilation by helmet or face mask in immunocompromised patients. A case–control study. Chest 126:1508–1515PubMedCrossRef

Conti G, Cavaliere F, Costa R, Craba A, Catarci S, Festa V, Proietti R, Antonelli M (2007) Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study. Respir Care 52:1463–1471PubMed

Navalesi P, Costa R, Ceriana P, Carlucci A, Prinianakis G, Antonelli M, Conti G, Nava S (2007) Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med 33:74–81PubMedCrossRef

Crimi C, Noto A, Princi P, Esquinas A, Nava S (2010) A European survey of noninvasive ventilation practices. Eur Respir J 36:362–369PubMedCrossRef

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

10.

Chiumello D, Pelosi P, Carlesso E, Severgnini P, Aspesi M, Gamberoni C, Antonelli M, Conti G, Chiaranda M, Gattinoni L (2003) Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive Care Med 29:1671–1679PubMedCrossRef

11.

Racca F, Appendini L, Gregoretti C, Stra E, Patessio A, Donner CF, Ranieri VM (2005) Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. J Appl Physiol 99:1262–1271PubMedCrossRef

12.

Vargas F, Thille A, Lyazidi A, Campo FR, Brochard L (2009) Helmet with specific settings versus facemask for noninvasive ventilation. Crit Care Med 37:1921–1928PubMedCrossRef

13.

Moerer O, Fischer S, Hartelt M, Kuvaki B, Quintel M, Neumann P (2006) Influence of two different interfaces for noninvasive ventilation compared to invasive ventilation on the mechanical properties and performance of a respiratory system. A lung model study. Chest 129:1424–1431PubMedCrossRef

14.

Georgopoulos D, Prinianakis G, Kondili E (2006) Bedside waveforms interpretation as a tool to identify patient–ventilator asynchronies. Intensive Care Med 32:34–47PubMedCrossRef

15.

Mojoli F, Venti A, Pozzi M, Via G, Braschi A (2009) Patient-ventilator interaction during pressure support ventilation: how to monitor and to improve it. Minerva Anestesiol 75:533–536

16.

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

17.

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

18.

Mojoli F, Iotti GA, 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

19.

Vignaux L, Tassaux D, Jolliet P (2007) Performance of noninvasive ventilation modes on ICU ventilators during pressure support: a bench model study. Intensive Care Med 33:1444–1451PubMedCrossRef

20.

Fabry B, Guttmann J, Eberhard L, Bauer T, Haberthiur C, Wolff G (1995) An analysis of desynchronization between the spontaneously breathing patient and ventilator during inspiratory pressure support. Chest 107:1387–1394PubMedCrossRef

21.

Schettino GP, Tucci MR, Sousa R, Barbas CS, Amato MB, Carvalho CR (2001) Mask mechanics and leak dynamics during noninvasive pressure support ventilation: a bench study. Intensive Care Med 27:1887–1891PubMedCrossRef

22.

Cavaliere F, Conti G, Costa R, Proietti R, Sciuto A, Masieri S (2004) Noise exposure during noninvasive ventilation with a helmet, a nasal mask and facial mask. Intensive Care Med 30:1755–1760PubMedCrossRef

Title: An optimized set-up for helmet noninvasive ventilation improves pressure support delivery and patient–ventilator interaction
Authors: Francesco Mojoli
Giorgio A. Iotti
Ilaria Currò
Marco Pozzi
Gabriele Via
Aaron Venti
Antonio Braschi
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2686-x

At a glance: The STEP trials

Springer Medicine

An optimized set-up for helmet noninvasive ventilation improves pressure support delivery and patient–ventilator interaction

Abstract

Objective

Subjects and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Subjects and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

A comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patients

Erratum to: Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

Posterior reversible encephalopathy syndrome in critically ill children: a case series

Physical restraint in mechanically ventilated ICU patients: a survey of French practice

Erratum to: Estimation of mean systemic filling pressure in postoperative cardiac surgery patients with three methods

Management of renal replacement therapy in ICU patients: an international survey