Use of Helmet CPAP in COVID-19 – A practical review

Amirfarzan, Houman; Cereda, Maurizio; Gaulton, Timothy G.; Leissner, Kay B.; Cortegiani, Andrea; Schumann, Roman; Gregoretti, Cesare

doi:10.1016/j.pulmoe.2021.01.008

Cited by 52 publications

(59 citation statements)

References 71 publications

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“…The distance of dispersion could reach 81.2cm when facemask pressure was set to 20cmH2O. However, the leakage of exhaled air was negligible when the helmet NIPPV connected to a two limb circuit equipped with filters and a good seal at the neck interface.When comparing with face masks or HFNC, helmet NIPPV significantly reduces SARS-CoV-2 aerosolization and exposure risk for healthcare workers in a recent report [ 73 ]. However, different degrees of exhaled air leakage could still be detected in helmets without a tight neck seal [ 63 ].…”

Section: Prudently Applying Non-invasive Respiratory Support (Nirs)mentioning

confidence: 99%

“…Potential problems also include, dead space ventilation may be strengthened by the increase of respiratory drive, minute ventilation and WOB that could lead to PSILI, fresh high flows are needed to avoid CO 2 rebreathing, noise, possible claustrophobia, armpits and neck skin injury, abdominal distension and eye irritation. Therefore, When increased respiratory drive, WOB, persistent dyspnea and the use of accessory muscles are present, IMV should be instituted as soon as possible [ 73 ].…”

Section: Prudently Applying Non-invasive Respiratory Support (Nirs)mentioning

confidence: 99%

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Respiratory care for the critical patients with 2019 novel coronavirus

Wang¹,

Lu²,

Yang³

et al. 2021

Respiratory Medicine

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through respiratory droplets, aerosols and close contact. Cross infections occur because viruses spread rapidly among humans. Nineteen percent (19%) of the infected patients developed severe pneumonia and acute respiratory distress syndrome (ARDS). Hypoxemia usually occurs and patients may require oxygen therapy or mechanical ventilation (MV) support. In this article, recently published clinical experience and observational studies were reviewed. Corresponding respiratory therapy regarding different stages of infection is proposed. Infection control principles and respiratory strategies including oxygen therapy, non-invasive respiratory support (NIRS), intubation evaluation, equipment preparation, ventilator settings, special maneuvers comprise of the prone position (PP), recruitment maneuver (RM), extracorporeal membrane oxygenation (ECMO), weaning and extubation are summarized. Respiratory equipment and device disinfection recommendations are worked up. We expect this review article could be used as a reference by health care workers in patient care while minimizing the risk of environmental contamination.

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Section: Prudently Applying Non-invasive Respiratory Support (Nirs)mentioning

confidence: 99%

Section: Prudently Applying Non-invasive Respiratory Support (Nirs)mentioning

confidence: 99%

Respiratory care for the critical patients with 2019 novel coronavirus

Wang¹,

Lu²,

Yang³

et al. 2021

Respiratory Medicine

View full text Add to dashboard Cite

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“…Otherwise 10cmH 2 0 was used for all patients given the risks of pressures >10cm H 2 0 such pneumothorax or pneumomediastinum. All patients on oxygen including those on CPAP were encouraged to do prone positioning(25) for at least 1 hour three times daily(26). Those unable to tolerate complete proning were encouraged to do semi prone positioning.…”

Section: Methodsmentioning

confidence: 99%

Continuous Positive Airway Pressure (CPAP) for Moderate to Severe Covid19 Acute Respiratory Distress Syndrome (CARDS) in a Resource limited setting

Hoole¹,

Qamar²,

Khan³

et al. 2021

Preprint

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Covid19 Acute Respiratory Distress Syndrome (CARDS) poses a challenge in management particularly due to limited capacity of ventilated intensive care beds and staffing, and this is exacerbated in resource poor settings with poor patient outcomes. Within this context CPAP has been trialled for CARDS although mainly in resource rich settings. This study retrospectively analyses the survival outcomes and characteristics of a cohort of patients with moderate to severe CARDS were treated exclusively with CPAP in a rural secondary level hospital in Pakistan with limited previous critical care expertise. 32 out of the 41 patients (78%) who were treated with CPAP survived overall (30/37 (81%) who were treated according to protocol), suggesting non inferiority to CARDS outcomes of critical care units employing Intubation and Mechanical Ventilation (IMV) in resource rich settings. This suggests CPAP should be promoted as an efficacious and cost-effective method for treating CARDS within the context of the pandemic surge of Covid19 in resource poor settings.

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“…The use of NRS 5 , 7 may pose an additional risk of infection for healthcare workers. Helmet CPAP (h-CPAP) 8 , 9 , 10 , 11 , 12 , 13 , 14 may reduce aerosolization and provide better comfort for patients 8 , 9 , 10 , 15 , in comparison with face masks. In patients receiving NRS, high tidal volumes have been correlated with large diaphragmatic swings, higher risk of self-induced lung injury 16 , and worse clinical outcomes 17 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19

et al. 2023

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Background: High generated tidal volumes (V t ) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing V t monitoring in patients affected by COVID-19. Methods: This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study. Main findings: Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of V t measurements was 100%. An out of scale of V t (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing. Conclusions: The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable V t monitoring. Further studies evaluating this configuration in larger patients’ cohorts are needed.

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Use of Helmet CPAP in COVID-19 – A practical review

Cited by 52 publications

References 71 publications

Respiratory care for the critical patients with 2019 novel coronavirus

Respiratory care for the critical patients with 2019 novel coronavirus

Continuous Positive Airway Pressure (CPAP) for Moderate to Severe Covid19 Acute Respiratory Distress Syndrome (CARDS) in a Resource limited setting

Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19

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