Computational evaluation of rebreathing and effective dead space on a helmet-like interface during the COVID-19 pandemic

Advantages and drawbacks of helmet noninvasive support in acute respiratory failure

INTRODUCTION

Non-invasive ventilation (NIV) represents an effective strategy for managing acute respiratory failure. Facemask NIV is strongly recommended in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnia and acute cardiogenic pulmonary edema (ACPE). Its role in managing acute hypoxemic respiratory failure (AHRF) remains a debated issue. NIV and continuous positive airway pressure (CPAP) delivered through the helmet are recently receiving growing interest for AHRF management.

AREAS COVERED

In this narrative review, we discuss the clinical applications of helmet support compared to the other available noninvasive strategies in the different phenotypes of acute respiratory failure.

EXPERT OPINION

Helmets enable the use of high positive end-expiratory pressure, which may protect from self-inflicted lung injury: in AHRF, the possible superiority of helmet support over other noninvasive strategies in terms of clinical outcome has been hypothesized in a network metanalysis and a randomized trial, but has not been confirmed by other investigations and warrants confirmation. In AECOPD patients, helmet efficacy may be inferior to that of face masks, and its use prompts caution due to the risk of CO₂ rebreathing. Helmet support can be safely applied in hypoxemic patients with ACPE, with no advantages over facemasks.

Breathing zone and exhaled air re-inhalation rate under transient conditions assessed with a computer-simulated person

The breathing zone of an individual indoors is usually defined as a finite region steadily formed in front of a face. Assuming the steady formation of the breathing zone, we propose a procedure for quantitatively identifying a breathing zone formed in front of a human face in the transient condition. This assumption is reasonable considering that the ventilation time scale of human respiration is sufficiently short compared to the ventilation time scale of a room. We used steady-state computational fluid dynamics (CFD) and a computationally simulated person (CSP). We present the probabilistic size of the breathing zone for various postures and breathing conditions. By analyzing unsteady inhalation and exhalation airflow characteristics via a CSP with a respiratory system, we also estimated the direct re-inhalation rate of the exhaled air. The results can be used for developing methods to control the long-term and low-contaminant concentration exposures.

The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings

A helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO₂ rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.