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Yang G, Lu H, Zhao Y, Li M. Risk factors for acute respiratory failure in patients with severe trauma. Asian J Surg 2024:S1015-9584(24)01705-6. [PMID: 39214810 DOI: 10.1016/j.asjsur.2024.07.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
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2
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Vergara J, Brenner MJ, Skoretz SA, Pandian V, Freeman-Sanderson A, Dorça A, Suiter D, Brodsky MB. Swallowing during provision of helmet ventilation: Review and provisional multidisciplinary guidance. J Intensive Care Soc 2024; 25:326-332. [PMID: 39224433 PMCID: PMC11366189 DOI: 10.1177/17511437241231704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Use of noninvasive ventilation provided by a helmet increased globally during and after the COVID-19 pandemic. This approach may reduce need for intubation and its associated clinical complications in critically ill patients. Use of helmet interface minimizes virus aerosolization while enabling verbal communication, oral feeding and coughing/expectoration of secretions during its administration. Although improved oral hydration is a recognized benefit of helmet NIV, relatively little is known about the safety and efficiency of swallowing during helmet NIV. Risk of aspiration is a key consideration given the fragile pulmonary status of critically ill patients requiring respiratory support, and therefore the decision to initiate oral intake is best made based on multidisciplinary input. We reviewed the current published evidence on NIV and its effects on upper airway physiology and swallowing function. We then presented a case example demonstrating preservation of swallowing performance with helmet NIV. Last, we offer provisional multidisciplinary guidance for clinical practice, and provide directions for future research.
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Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, Campinas, SP, Brazil
| | - Michael J Brenner
- Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stacey A Skoretz
- School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD, USA
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Australia
| | - Alessandra Dorça
- Department of Health Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Debra Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington, USA
| | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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3
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Rittayamai N, Pravarnpat C, Srilam W, Bunyarid S, Chierakul N. Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study. J Thorac Dis 2023; 15:5466-5474. [PMID: 37969272 PMCID: PMC10636453 DOI: 10.21037/jtd-23-732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Background Noninvasive ventilation (NIV) is recommended for use in patients with acute respiratory failure of various etiologies. However, we do not know whether the use of NIV in general medical wards is safe and effective. This study aimed to evaluate the safety and efficacy of using NIV and factors associated with NIV failure in general medical wards. Methods A prospective cohort study was conducted in general medical wards of the University Hospital. Adult patients with acute respiratory failure treated with NIV were enrolled. The subjects were managed by a multidisciplinary care team that was well trained in the NIV device. The primary outcome was the rate of NIV failure at 48 hours. Secondary outcomes included hospital mortality and factors associated with NIV failure. Results A total of 86 patients were enrolled. The mean age was 70±17 years old. The Acute Physiology and Chronic Health Evaluation (APACHE) III and the Sequential Organ Failure Assessment (SOFA) scores were 56±17 and 4±3, respectively. The most common indication of NIV use was cardiogenic pulmonary edema (34.9%). The rate of NIV failure at 48 hours and hospital mortality were 20.9% and 12.8%, respectively. The SOFA score was associated with failure of NIV at 48 hours [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.16-1.89; P=0.002]. Conclusions NIV was safe and effective on general medical wards. Cardiogenic pulmonary edema was the most common indication for the application of NIV. The SOFA score was associated with the failure of NIV at 48 hours.
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Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalinee Pravarnpat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wichian Srilam
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satit Bunyarid
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nitipatana Chierakul
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Adi O, Fong CP, Keong YY, Apoo FN, Roslan NL. Helmet CPAP in the emergency department: A narrative review. Am J Emerg Med 2023; 67:112-119. [PMID: 36870251 DOI: 10.1016/j.ajem.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND The choice of correct interface for the right patient is crucial for the success of non-invasive ventilation (NIV) therapy. Helmet CPAP is a type of interface used to deliver NIV. Helmet CPAP improves oxygenation by keeping the airway open throughout the breathing cycle with positive end-expiratory pressure (PEEP). OBJECTIVE This narrative review describes the technical aspects and clinical indications of helmet continuous positive airway pressure (CPAP). In addition, we explore the advantages and challenges faced using this device at the Emergency Department (ED). DISCUSSION Helmet CPAP is tolerable than other NIV interfaces, provides a good seal and has good airway stability. During Covid-19 pandemic, there are evidences it reduced the risk of aerosolization. The potential clinical benefit of helmet CPAP is demonstrated in acute cardiogenic pulmonary oedema (ACPO), Covid-19 pneumonia, immunocompromised patient, acute chest trauma and palliative patient. Compare to conventional oxygen therapy, helmet CPAP had been shown to reduce intubation rate and decrease mortality. CONCLUSION Helmet CPAP is one of the potential NIV interface in patients with acute respiratory failure presenting to the emergency department. It is better tolerated for prolonged usage, reduced intubation rate, improved respiratory parameters, and offers protection against aerosolization in infectious diseases.
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Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Yip Yat Keong
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Farah Nuradhwa Apoo
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Nurul Liana Roslan
- Resuscitation & Emergency Critical Care Unit (RECCU), Trauma & Emergency Department, Hospital Kuala Lumpur, Malaysia
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5
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Neves H, Parola V, Bernardes RA, Sousa J, Coelho A, Dixe MDA, Catela N, Cruz A. Helmet-Noninvasive Ventilation for Hospitalized Critically Ill COVID-19 Patients: Has Vaccination and the New Variants Changed Evidence? NURSING REPORTS 2022; 12:528-535. [PMID: 35894041 PMCID: PMC9326629 DOI: 10.3390/nursrep12030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Noninvasive ventilation (NIV) is a technique for breathing support that significantly improves gas exchange and vital signs, reducing intubation and mortality rates. Helmets, unlike facemasks, allow for longer-term treatment and better ventilation, also being more cost-effective. As of today, we have found no reviews addressing this topic. This review aims to identify, map, and describe the characteristics of the use of noninvasive ventilation through helmet interface in critically ill COVID-19 adult patients hospitalized in acute care settings throughout the multiple moments that defined the COVID-19 pandemic. This scoping review will follow the methodology for scoping reviews proposed by JBI. A set of relevant electronic databases will be searched using terms such as COVID-19, helmet, and noninvasive ventilation. Two reviewers will independently perform the study selection regarding their eligibility. Data extraction will be accomplished using a researcher’s developed tool considering the review questions. Findings will be presented in tables and a narrative description that aligns with the review’s objective. This scoping review will consider any quantitative, qualitative, mixed-methods studies and systematic review designs for inclusion, focusing on the use of helmet on critically ill adult patients with COVID-19 hospitalized in acute care settings.
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Affiliation(s)
- Hugo Neves
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, 3045-043 Coimbra, Portugal; (H.N.); (V.P.); (A.C.); (A.C.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence, 3045-043 Coimbra, Portugal
| | - Vítor Parola
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, 3045-043 Coimbra, Portugal; (H.N.); (V.P.); (A.C.); (A.C.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence, 3045-043 Coimbra, Portugal
| | - Rafael A. Bernardes
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, 3045-043 Coimbra, Portugal; (H.N.); (V.P.); (A.C.); (A.C.)
- Correspondence:
| | - Joana Sousa
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.S.); (M.d.A.D.); (N.C.)
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Adriana Coelho
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, 3045-043 Coimbra, Portugal; (H.N.); (V.P.); (A.C.); (A.C.)
- Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence, 3045-043 Coimbra, Portugal
| | - Maria dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.S.); (M.d.A.D.); (N.C.)
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Nuno Catela
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.S.); (M.d.A.D.); (N.C.)
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Arménio Cruz
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra, 3045-043 Coimbra, Portugal; (H.N.); (V.P.); (A.C.); (A.C.)
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Taghinezhad F, Kaffashian M, Kalvandi G, Shafiei E. Explanation of COVID-19 Mortality Using Artificial Neural Network Based on Underlying and Laboratory Risk Factors in Ilam, Iran. ARCHIVES OF RAZI INSTITUTE 2022; 77:1327-1332. [PMID: 36618315 PMCID: PMC9759234 DOI: 10.22092/ari.2021.355438.1684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/10/2021] [Indexed: 01/10/2023]
Abstract
The spread of new waves of coronavirus outbreaks, high mortality rates, and time-consuming and numerous challenges in achieving collective safety through vaccination and the need to prioritize the allocation of vaccines to the general population have led to the continued identification of risk factors associated with mortality in patients through innovative strategies and new statistical models. In this study, an artificial neural network (ANN) model was used to predict morbidity in patients with coronavirus disease 2019 (COVID-19). Data of 2,206 patients were extracted from the registry program of Shahid Mostafa Khomeini Hospital in Ilam, Iran, and were randomly analyzed in two training (1,544) and testing (662) groups. By fitting different models of a three-layer neural network, 12 variables could explain more than 77% of the mortality variance in COVID-19 patients. These findings could be used to better mortality management, vaccination prioritization, public education, and quarantine, and allocation of intensive care beds to reduce COVID-19 mortality. The results also confirmed the power of a better explanation of ANN models to predict the mortality of patients.
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Affiliation(s)
- F Taghinezhad
- Clinical Research Development Unit, Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - M Kaffashian
- Department of Physiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Gh Kalvandi
- Department of Pediatrics, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - E Shafiei
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
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7
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A pilot crossover trial assessing the exercise performance patients chronic obstructive pulmonary disease. Sci Rep 2022; 12:4158. [PMID: 35264615 PMCID: PMC8907196 DOI: 10.1038/s41598-022-07698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Noninvasive ventilation improves exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, the effect of helmet ventilation (HV) on the short-term self-paced exercise performance of patients with COPD remains unclear. This study investigated the use of HV during a 6 min walk test (6MWT) and analyzed its short-term cardiopulmonary outcomes in patients with stable COPD. A single-site crossover trial was conducted in a pulmonary rehabilitation outpatient department. A total of 20 stable patients with COPD without disability were enrolled. The participants performed 6MWTs with and without HV on two consecutive days. The outcome measures were the distance walked in the 6MWT and the physiological and cardiopulmonary parameters. The mean difference in meters walked between the HV-aided and unaided walk tests was 15.4 ± 37.2 (95% confidence interval: − 2.03 to 32.8 m; p = .145). During the 6MWT, the peak heart rate was significantly higher when walking was aided by HV than when it was unaided (p < .001). The energy expenditure index, walking speed, oxygen saturation nadir, and hemodynamic parameters were comparable. Although carbon dioxide levels inside the helmet increased after the walk test, the participants’ transcutaneous carbon dioxide measurements remained unchanged. HV did not improve the short-term self-paced exercise performance in patients with stable mild-to-moderate COPD. Further research should focus on noninvasive ventilation delivered via helmets in exercise training to determine the setting strategy, breathing circuit configuration, and effects of regular exercise. ClinicalTrial.gov: NCT04156724; IRB number: C108032.
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8
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Saxena A, Nazir N, Pandey R, Gupta S. Comparison of Effect of Non-invasive Ventilation Delivered by Helmet vs Face Mask in Patients with COVID-19 Infection: A Randomized Control Study. Indian J Crit Care Med 2022; 26:282-287. [PMID: 35519929 PMCID: PMC9015936 DOI: 10.5005/jp-journals-10071-24155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aims We compared the effectiveness of non-invasive ventilation (NIV) provided by helmet mask vs face mask in patients with COVID-19. Methods and materials Between March and May 2021, a single-center, prospective, open-label randomized controlled research was undertaken. Sixty patients were randomly assigned to one of two groups based on the NIV delivery interface. In group I (n = 30) helmet mask was used and in group II (n = 30) face mask was used for delivery of NIV. The proportion of patients in each group who required endotracheal intubation was the primary outcome. The duration of NIV, length of stay in the intensive care unit (ICU), hospital mortality, ratio of partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2), respiratory rate, patient comfort, and complications were all documented as secondary outcomes. Results In both groups, demographics, clinical characteristics, and treatment received were comparable. Around 10% of patients in the helmet mask group were intubated, while 43.3% of patients in the face mask group were intubated (p = 0.004). The two groups demonstrated similar hemodynamic patterns. The use of a helmet mask, on the other hand, resulted in enhanced oxygenation (263.57 ± 31.562 vs 209.33 ± 20.531, p = 0.00), higher patient satisfaction (p = 0.001), a lower risk of complications, and a shorter NIV and ICU stay (p = 0.001) (4.53 ± 0.776 vs 7.60 ± 1.354, p = 0.00 and 6.37 ± 0.556 vs 11.57 ± 2.161, p = 0.00). Conclusion Helmet mask could be a reliable interface for delivery of NIV in COVID-19 and results in a lower rate of endotracheal intubation, better oxygenation with greater patient comfort and shorter ICU stay as compared to face mask used for NIV. How to cite this article Saxena A, Nazir N, Pandey R, Gupta S. Comparison of Effect of Non-invasive Ventilation Delivered by Helmet vs Face Mask in Patients with COVID-19 Infection: A Randomized Control Study. Indian J Crit Care Med 2022;26(3):282-287.
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Affiliation(s)
- Anupriya Saxena
- Anaesthesia, Government Institute of Medical Sciences, New Delhi, India
- Anupriya Saxena, Anaesthesia, Government Institute of Medical Sciences, New Delhi, India, Phone: +91 9953090044, e-mail:
| | - Nazia Nazir
- Anesthesiology and Critical Care, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Ruchi Pandey
- Community Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Savita Gupta
- Department of Anaesthesia, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
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9
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Mu SC, Chien YH, Lai PZ, Chao KY. Helmet Ventilation for Pediatric Patients During the COVID-19 Pandemic: A Narrative Review. Front Pediatr 2022; 10:839476. [PMID: 35186812 PMCID: PMC8847782 DOI: 10.3389/fped.2022.839476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
The air dispersion of exhaled droplets from patients is currently considered a major route of coronavirus disease 2019 (COVID-19) transmission, the use of non-invasive ventilation (NIV) should be more cautiously employed during the COVID-19 pandemic. Recently, helmet ventilation has been identified as the optimal treatment for acute hypoxia respiratory failure caused by COVID-19 due to its ability to deliver NIV respiratory support with high tolerability, low air leakage, and improved seal integrity. In the present review, we provide an evidence-based overview of the use of helmet ventilation in children with respiratory failure.
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Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pin-Zhen Lai
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
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10
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Ahmadinejad M, Moghaddam MA, Shahesmaeili A, Mayel M. Two Supportive Methods on Outcome of Patients with Chest Trauma. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/akte52dksk] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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11
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Coppadoro A, Zago E, Pavan F, Foti G, Bellani G. The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:327. [PMID: 34496927 PMCID: PMC8424168 DOI: 10.1186/s13054-021-03746-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/20/2021] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
| | - Elisabetta Zago
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Fabio Pavan
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy
| | - Giacomo Bellani
- ASST Monza, San Gerardo Hospital, Monza, Italy. .,Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy.
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12
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Chaudhuri D, Jinah R, Burns KEA, Angriman F, Ferreyro B, Munshi L, Goligher E, Scales D, Cook DJ, Mauri T, Rochwerg B. Helmet non-invasive ventilation compared to facemask non-invasive ventilation and high flow nasal cannula in acute respiratory failure: a systematic review and meta-analysis. Eur Respir J 2021; 59:13993003.01269-2021. [PMID: 34413155 DOI: 10.1183/13993003.01269-2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although small randomised controlled trials (RCTs) and observational studies have examined helmet non-invasive ventilation (NIV), uncertainty remains regarding its role. We conducted a systematic review and meta-analysis to examine the effect of helmet NIV compared to facemask NIV or high flow nasal cannula (HFNC) in acute respiratory failure. METHODS We searched multiple databases to identify RCTs and observational studies reporting on at least one of mortality, intubation, ICU length of stay, NIV duration, complications, or comfort with NIV therapy. We assessed study risk of bias (ROB) using the Cochrane ROB tool for RCTs and the Ottawa-Newcastle scale for observational studies and rated certainty of pooled evidence using GRADE. RESULTS We separately pooled data from 16 RCTs (n=949) and 8 observational studies (n=396). Compared to facemask NIV, based on low certainty evidence, helmet NIV may reduce mortality (relative risk (RR) 0.56, 95% confidence interval (CI) (0.33 to 0.95)), and intubation (RR 0.35, 95% CI (0.22 to 0.56)) in both hypoxic and hypercapnic respiratory failure but may have no effect on duration of NIV. There was an uncertain effect of helmet on ICU length of stay and development of pressure sores. Data from observational studies was consistent with the foregoing findings but of lower certainty. Based on low and very low certainty data, helmet NIV may reduce intubation compared to HFNC, but its effect on mortality is uncertain. CONCLUSION Compared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet compared to HFNC remains uncertain.
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Affiliation(s)
- Dipayan Chaudhuri
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Authors share co-first authorship
| | - Rehman Jinah
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Authors share co-first authorship
| | - Karen E A Burns
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada
| | - Federico Angriman
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation. Dalla Lana School of Public Health, Univeristy of Toronto, Toronto, Ontario, Canada
| | - Bruno Ferreyro
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation. Dalla Lana School of Public Health, Univeristy of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Ewan Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Respirology, University Health Network, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Damon Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation. Dalla Lana School of Public Health, Univeristy of Toronto, Toronto, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Critical Care Medicine, St. Joseph's Hospital, Hamilton, Ontario, Canada
| | - Tommaso Mauri
- Department of Pathophysiology and Transplantation, University of Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Guo K, Liu G, Wang W, Guo G, Liu Q. Effects of high-flow nasal oxygen cannula versus other noninvasive ventilation in extubated patients: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Respir Med 2021; 16:109-119. [PMID: 34348551 DOI: 10.1080/17476348.2021.1964363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES A systematic review and meta-analysis were performed to compare the effects of high-flow nasal oxygen cannula (HFNC) and noninvasive ventilation (NIV) in extubated patients with respiratory insufficiency. METHODS The Cochrane Library, PubMed, and ClinicalTrials.gov were searched from inception to 28 February 2021, to identify randomized controlled trials. The primary outcome was reintubation within 24-72 hours after a planned extubation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Six articles with1746 patients were included. The effect of HFNC on the reintubation rate was noninferior to that of NIV (OR = 1.11, 95% CI: 0.85-1.44). The rate of treatment failure was 20.40% with HFNC versus 20.92% with NIV; this difference was nonsignificant (OR = 0.97, 95% CI: 0.72-1.32, P = 0.85). HFNC reduced the rates of skin lesion occurrence (10.28% versus 23.82%, OR = 0.37, 95% CI: 0.26-0.53, P < 0.00001) and post-extubation respiratory failure (23.76% versus 25.56%, OR = 0.64, 95% CI: 0.46-0.88, P = 0.006), compared with NIV. CONCLUSIONS In extubated patients, HFNC was noninferior to NIV in the rate of reintubation and treatment failure. Compared with NIV, HFNC decreased the occurrence of skin lesions and post-extubation respiratory failure.
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Affiliation(s)
- Kaiyuan Guo
- Department of 2018 Grade Clinical Medicine, Medical College of Zhengzhou University, Zhengzhou, PR China
| | - Gang Liu
- Department of Emergency Intensive Care Ward, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Wei Wang
- Department of Clinical Evaluation, Henan Medical Association, Zhengzhou, PR China
| | - Guancheng Guo
- Department of Emergency Intensive Care Ward, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Qi Liu
- Department of Emergency Intensive Care Ward, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.,Department of Translational Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.,Department of Henan Medical Key Laboratory of Emergency and Trauma Research, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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