Oronasal mask <i>versus</i> helmet in acute hypercapnic respiratory failure

Pisani, Lara; Mega, Chiara; Vaschetto, Rosanna; Bellone, Andrea; Scala, Raffaele; Cosentini, Roberto; Musti, Muriel Assunta; Forno, Manuela Del; Grassi, Mario; Fasano, Luca; Navalesi, Paolo; Nava, Stefano

doi:10.1183/09031936.00053814

Cited by 50 publications

(63 citation statements)

References 32 publications

(57 reference statements)

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“…Fifty-four studies were excluded after examination of the full text. Finally, 11 studies involving 621 patients, with six RCTs [15, 16, 29–32] and five case-control studies [14, 17, 20, 33, 34], were included for the meta-analysis. These studies recruited patients admitted to ICUs [14, 15, 20, 29–32, 34], emergency departments [33], high dependency units [16], and departments of hematology [17] in different countries: Italy [14–17, 20, 34], Turkey [29, 30], Brazil [31], America [32], and France [33].…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, there has been no clear consensus on its effect until now. Whether NIV delivered by helmet could reduce the intubation rate and mortality was still causing controversy [15, 16], furthermore, the effect on gas exchange was also confusing. Some studies indicated NIV delivered by helmet could improve oxygenation further compared with a face mask [17, 18], while others showed there was no significant difference in oxygenation [19–21], and some studies even demonstrated helmet-induced carbon dioxide rebreathing [22].…”

Section: Introductionmentioning

confidence: 99%

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Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

et al. 2016

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BackgroundNoninvasive ventilation (NIV) has proved to be a useful technique for breathing support. However, complications, discomfort, and failure of NIV were commonly caused by the mask. Therefore, the helmet was developed to improve performance and reduce complications; however, there has been no conclusive results on its effect until now. Thus, we performed a systematic review and meta-analysis to investigate the effect of NIV with a helmet versus the control strategy in patients with acute respiratory failure (ARF).MethodsWe searched Cochrane Library, PubMed, Ovid, and Embase databases and bibliographies of relevant articles published before June 2016. Randomized and case-control studies that adopted the helmet as an NIV interface and compared it with another interface were included. The primary outcomes were hospital mortality, intubation rate, and complications. The secondary outcomes included the length of intensive care unit (ICU) stay, gas exchange, and respiratory rate. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated by the Mantel-Haenszel method and mean difference by the inverse variance method in a fixed effect model or random effects model according to the heterogeneity.ResultsA total of 11 studies involving 621 patients were included. The overall hospital mortality was 17.53 % in the helmet NIV group versus 30.67 % in the control group. Use of the helmet was associated with lower hospital mortality (OR 0.43, 95 % CI 0.26 to 0.69, p = 0.0005), intubation rate (OR 0.32, 95 % CI 0.21 to 0.47, P < 0.00001), and complications (OR 0.6, 95 % CI 0.4 to 0.92, P = 0.02). In contrast, there was no significant difference in gas exchange and ICU stay (P >0.05). Subgroup analysis found the helmet reduced mortality mainly in hypoxemic ARF patients (P < 0.05) and a lower intubation rate was shown in randomized trials; fewer complications caused by the helmet might be restricted to case-control trials. Additionally, the effect of the helmet on PaCO2 was influenced by type of ARF and ventilation mode (P <0.00001).ConclusionNIV with a helmet was associated with reduced hospital mortality and intubation requirement. The helmet was as effective as the mask in gas exchange with no additional advantage. Large randomized controlled trials are needed to provide more robust evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

et al. 2016

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“…In a recent clinical trial in COPD subjects, the mean PEEP found by the authors in the helmet group was 7.7 mm Hg as well. 36 …”

Section: Discussionmentioning

confidence: 99%

“…31 A different set of NIV interfaces will certainly have an impact, since internal volume and compliance might vary, 34 as lately shown for a new ventilation helmet where no significant asynchrony has been found. 33,36 We kept the different settings constant irrespective of the interface used to permit comparable results. 37 Especially in the helmet, the efficiency of pressure transmission and patient-ventilator interaction can be improved by compensating for its larger compliance.…”

Section: Discussionmentioning

confidence: 99%

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

et al. 2015

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BACKGROUND: During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction. METHODS: A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H 2 O) using the ventilator's invasive and NIV mode with and without an applied leakage. RESULTS: Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001). CONCLUSION: Augmenting the cycling criterion above the default setting (20 -30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered.

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“…These effects are likely achieved by reducing the upward displacement of the helmet during ventilator insufflation, while guaranteeing adequate comfort and eliminating the need for the armpit braces (12,19). While it is unclear whether these physiologic improvements translate in better outcome improvement in hypoxemic ARF, a recent pilot RCT conducted in patients with COPD exacerbations, previously shown to be the worst population for helmet NIV (17), found this new device to be equally effective than the facial mask (20).…”

mentioning

confidence: 99%