Nasal High Flow Delivered within the Helmet: A New Noninvasive Respiratory Support

Mauri, Tommaso; Spinelli, Elena; Mariani, Massimiliano; Guzzardella, Amedeo; Prete, Chiara Del; Carlesso, Eleonora; Tortolani, Donatella; Tagliabue, Paola; Pesenti, Antonio

doi:10.1164/rccm.201806-1124le

Cited by 14 publications

(21 citation statements)

References 11 publications

(14 reference statements)

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“…In healthy volunteers unaware of the study purposes, we found that adding HFNC to CPAP (compared to CPAP) (1) did not importantly alter either the preset airway pres- 14 (12)(13)(14)(15)(16)(17)(18)(19) 19 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 21 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) .01 †; .001* ‡; .001* § 21 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 21 (18)(19)(20)(21)…”

Section: Discussionmentioning

confidence: 93%

“…Recently, Mauriusb et al 16 found this combination capable of providing stable CPAP and effective CO 2 wash-out from the upper airways with negligible CO 2 rebreathing. Nonetheless, because of the complex interplay between CPAP and HFNC, the amount of truly applied airway pressure, diaphragm function, and temperature inside the helmet might be affected to some extent.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

et al. 2019

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BACKGROUND: This study assessed the effects of a new interface that combined CPAP 10 cm H 2 O by using a helmet with high-flow nasal cannula (HFNC) at varying flows in healthy volunteers. Outcome measures included pharyngeal pressures, diaphragm kinetics, breathing frequency, the temperature inside the helmet, and comfort. METHODS: After baseline assessment during spontaneous breathing, HFNC was applied at flows of 30, 40, and 50 L/min. Successively, the volunteers underwent helmet CPAP at 10 cm H 2 O and CPAP ؉ HFNC at flows of 30, 40, and 50 L/min. We measured the variations of pharyngeal pressures at end-expiration and end-inspiration, referenced to spontaneous breathing for HFNC and to CPAP for CPAP ؉ HFNC, diaphragm displacement and thickness at end-expiration and thickness at end-inspiration, breathing frequency, the temperature inside the helmet, the occurrence of the fog effect, and comfort. RESULTS: Variations of pharyngeal pressures at end-inspiration changes were small overall and clinically unimportant. With the mouth closed, at increasing HFNC flow, variations of pharyngeal pressures at endexpiration increased during both HFNC (from 2.8 up to 7.7) and, to a lesser extent, CPAP ؉ HFNC (from 2.7 up to 3.8) (P < .001 for all comparisons). These variations were attenuated during open-mouth breathing. HFNC > 40 L/min and CPAP ؉ HFNC > 40 L/min compared with spontaneous breathing and CPAP, respectively, increased diaphragm displacement (P ‫؍‬ .001), thickness at end-inspiration and thickness at end-expiration (P < .003 for both). At all flows, breathing frequency was slightly, although significantly, lower with CPAP ؉ HFNC than with HFNC alone (P < .003). The temperature inside the helmet increased slightly and insignificantly at flows of <40 L/min with CPAP ؉ HFNC compared with CPAP alone. The fog effect never occurred, whereas comfort was always rated as optimal, without differences between trials. CONCLUSIONS: CPAP ؉ HFNC was well tolerated, with no adverse effects. Based on our findings, there was no need to vary the CPAP level when adding HFNC. At least in healthy subjects, CPAP ؉ HFNC at 30 L/min seemed to be the best combination.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

et al. 2019

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“…Recently, an experimental study on healthy subjects has shown that a combination of HFNC delivering nasal high flow within a sealed helmet connected to a PEEP valve can provide a stable PEEP and effective washout of carbon dioxide from the upper airway with negligible carbon dioxide rebreathing [42]. More studies are needed to determine whether HFNC has advantages over NIV in managing different types of respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks

et al. 2019

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BackgroundHigh-flow nasal cannula (HFNC) is an emerging therapy for respiratory failure but the extent of exhaled air dispersion during treatment is unknown. We examined exhaled air dispersion during HFNC therapy versus continuous positive airway pressure (CPAP) on a human patient simulator (HPS) in an isolation room with 16 air changes·h−1.MethodsThe HPS was programmed to represent different severity of lung injury. CPAP was delivered at 5–20 cmH2O via nasal pillows (Respironics Nuance Pro Gel or ResMed Swift FX) or an oronasal mask (ResMed Quattro Air). HFNC, humidified to 37°C, was delivered at 10–60 L·min−1 to the HPS. Exhaled airflow was marked with intrapulmonary smoke for visualisation and revealed by laser light-sheet. Normalised exhaled air concentration was estimated from the light scattered by the smoke particles. Significant exposure was defined when there was ≥20% normalised smoke concentration.ResultsIn the normal lung condition, mean±sd exhaled air dispersion, along the sagittal plane, increased from 186±34 to 264±27 mm and from 207±11 to 332±34 mm when CPAP was increased from 5 to 20 cmH2O via Respironics and ResMed nasal pillows, respectively. Leakage from the oronasal mask was negligible. Mean±sd exhaled air distances increased from 65±15 to 172±33 mm when HFNC was increased from 10 to 60 L·min−1. Air leakage to 620 mm occurred laterally when HFNC and the interface tube became loose.ConclusionExhaled air dispersion during HFNC and CPAP via different interfaces is limited provided there is good mask interface fitting.

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“…This suggests that these more protective ventilator settings may have reduced lung injury. A recent physiological study showed in healthy volunteers that NIV delivered through Helmet (without pressure support) was able to deliver a higher level of PEEP as compared with HFNT 60 . The combination of HFNT plus Helmet might present additive physiologic effects, potentially representing a new, non-invasive respiratory support.…”

Section: Barcelona Respiratory Networkmentioning

confidence: 99%

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Ferrer¹

2021

BRN

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There is strong evidence suggesting use of non-invasive ventilation in patients with severe exacerbation of chronic obstructive pulmonary disease, while use of high-flow nasal therapy in this indication is promising. However, current data suggest that non-invasive ventilation provides limited benefit in de novo acute respiratory failure, and specifically in immunocompromised patients. In this indication, high-flow nasal therapy is increasingly used, but new studies are needed to confirm its superiority over standard oxygen or non-invasive ventilation. In patients undergoing planned extubation, high-flow nasal therapy is effective in preventing re-intubation in patients at lower risk for this complication, while the combination of both non-invasive ventilation and high-flow nasal therapy appears the best strategy for those at higher risk for post-extubation respiratory failure. Finally, providing supplemental oxygen and ventilation from the start of pre-oxygenation until laryngoscopy could be the most effective approach to preventing life-threatening hypoxaemia for patients undergoing endotracheal intubation.

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Nasal High Flow Delivered within the Helmet: A New Noninvasive Respiratory Support

Cited by 14 publications

References 11 publications

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP

Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

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