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Beliero AM, Lázaro APP, Zaranza MDS, Lima GMC, Guimarães ÁR, Aragão NL, Meneses GC, Holanda MA, Albuquerque PLMM, da Silva GB, Fernandes PFCBC. ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome. J Bras Pneumol 2024; 49:e20230227. [PMID: 38232252 PMCID: PMC10769475 DOI: 10.36416/1806-3756/e20230227] [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: 07/24/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.
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Affiliation(s)
- Andréa Mazza Beliero
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Fortaleza (CE) Brasil
| | - Ana Paula Pires Lázaro
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Marza de Sousa Zaranza
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Giovanna Mazza Cruz Lima
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Álvaro Rolim Guimarães
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Nilcyeli Linhares Aragão
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Gdayllon Cavalcante Meneses
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Marcelo Alcantara Holanda
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
- . Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Polianna Lemos Moura Moreira Albuquerque
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Geraldo Bezerra da Silva
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
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Płatek P, Daniel N, Cieplak K, Sarzyński M, Siemiński P, Sadownik B, Andruszkiewicz P, Wróblewski Ł. 3D Printing in the Fight Against Covid-19. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2023; 16:167-182. [PMID: 37435359 PMCID: PMC10332420 DOI: 10.2147/mder.s406757] [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: 02/11/2023] [Accepted: 05/16/2023] [Indexed: 07/13/2023] Open
Abstract
Purpose The paper describes the design concept and findings from technological and initial clinical trials conducted to develop a helmet for non-invasive oxygen therapy using positive pressure, known as hCPAP (Helmet Continuous Positive Airway Pressure). Methods The study utilized PET-G filament, a recommended material for medical applications, along with the FFF 3D printing technique. Additional technological investigations were performed for the production of fitting components. The authors proposed a parameter identification method for 3D printing, which reduced the time and cost of the study while ensuring high mechanical strength and quality of the manufactured elements. Results The proposed 3D printing technique facilitated the rapid development of an ad hoc hCPAP device, which was utilized in preclinical testing and treatment of Covid-19 patients, and yielded positive results. Based on the promising outcomes of the preliminary tests, further development of the hCPAP device's current version was pursued. Conclusion The proposed approach offered a crucial benefit by significantly reducing the time and costs involved in developing customized solutions to aid in the fight against the Covid-19 pandemic.
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Affiliation(s)
- Paweł Płatek
- Faculty of Mechatronics, Armament and Aviation, Military University of Technology, Warsaw, Poland
| | - Natalia Daniel
- Faculty of Mechatronics, Armament and Aviation, Military University of Technology, Warsaw, Poland
| | - Kamil Cieplak
- Faculty of Mechatronics, Armament and Aviation, Military University of Technology, Warsaw, Poland
| | - Marcin Sarzyński
- Faculty of Mechatronics, Armament and Aviation, Military University of Technology, Warsaw, Poland
| | - Przemysław Siemiński
- Faculty of Automotive and Construction Machinery Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Bartosz Sadownik
- 2nd Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Central Teaching Hospital, Central Teaching Hospital, Warsaw, Poland
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Andruszkiewicz
- 2nd Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Central Teaching Hospital, Central Teaching Hospital, Warsaw, Poland
| | - Łukasz Wróblewski
- 2nd Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Central Teaching Hospital, Central Teaching Hospital, Warsaw, Poland
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Mazza M, Fiorentino G, Esquinas AM. ELMO helmet for CPAP to treat COVID-19-related acute hypoxemic respiratory failure outside the ICU: aspects of/comments on its assembly and methodologyAuthors' replyPatient self-inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathingELMO 1 0: a helmet interface for CPAP and high-flow oxygen deliveryProtecting healthcare workers from SARS-CoV-2 infection practical indications. J Bras Pneumol 2022; 48:e20220072. [PMID: 35584469 PMCID: PMC9064639 DOI: 10.36416/1806-3756/e20220072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mariano Mazza
- . Unità Operativa Complessa di Pneumologia Semintensiva COVID, Azienda Ospedaliera Sant'Anna e San Sebastiano di Rilievo Nazionale e alta Specializzazione, Caserta, Italia
| | - Giuseppe Fiorentino
- . Unità Operativa Complessa di Fisiopatologia e Riabilitazione Respiratoria P.O. Monaldi, 1o Utsir Covid PO, Ospedale Cotugno, Azienda Ospedaliera dei Colli, Napoli, Italia
| | - Antonio M Esquinas
- . Intensive Care and Non Invasive Ventilatory Unit, Hospital General Universitario Jose M Morales Meseguer, Murcia, España
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Tomaz BS, Gomes GC, Lino JA, Menezes DGAD, Soares JB, Furtado V, Soares Júnior L, Farias MDSQ, Lima DLN, Pereira EDB, Holanda MA. ELMO, a new helmet interface for CPAP to treat COVID-19-related acute hypoxemic respiratory failure outside the ICU: a feasibility study. J Bras Pneumol 2022; 48:e20210349. [PMID: 35137871 PMCID: PMC8836630 DOI: 10.36416/1806-3756/e20210349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/28/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: To assess the feasibility of using a new helmet interface for CPAP, designated ELMO, to treat COVID-19-related acute hypoxemic respiratory failure (AHRF) outside the ICU. Methods: This was a proof-of-concept study involving patients with moderate to severe AHRF secondary to COVID-19 admitted to the general ward of a public hospital. The intervention consisted of applying CPAP via the ELMO interface integrated with oxygen and compressed air flow meters (30 L/min each) and a PEEP valve (CPAP levels = 8-10 cmH2O), forming the ELMOcpap system. The patients were monitored for cardiorespiratory parameters, adverse events, and comfort. Results: Ten patients completed the study protocol. The ELMOcpap system was well tolerated, with no relevant adverse effects. Its use was feasible outside the ICU for a prolonged amount of time and was shown to be successful in 60% of the patients. A CPAP of 10 cmH2O with a total gas flow of 56-60 L/min improved oxygenation after 30-to 60-min ELMOcpap sessions, allowing a significant decrease in estimated FIO2 (p = 0.014) and an increase in estimated PaO2/FIO2 ratio (p = 0.008) within the first hour without CO2 rebreathing. Conclusions: The use of ELMOcpap has proven to be feasible and effective in delivering high-flow CPAP to patients with COVID-19-related AHRF outside the ICU. There were no major adverse effects, and ELMO was considered comfortable. ELMOcpap sessions significantly improved oxygenation, reducing FIO2 without CO2 rebreathing. The overall success rate was 60% in this pilot study, and further clinical trials should be carried out in the future. (ClinicalTrials.gov identifier: NCT04470258 [http://www.clinicaltrials.gov/])
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Affiliation(s)
| | - Gabriela Carvalho Gomes
- . Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico - FUNCAP - Fortaleza (CE) Brasil
| | - Juliana Arcanjo Lino
- . Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico - FUNCAP - Fortaleza (CE) Brasil
| | | | - Jorge Barbosa Soares
- . Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico - FUNCAP - Fortaleza (CE) Brasil
| | - Vasco Furtado
- . Universidade de Fortaleza - UNIFOR - Fortaleza (CE) Brasil
| | | | | | | | | | - Marcelo Alcantara Holanda
- . Universidade Federal do Ceará - UFC - Fortaleza (CE) Brasil.,. Escola de Saúde Pública do Ceará Paulo Marcelo Martins Rodrigues, Fortaleza (CE) Brasil
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Holanda MA. Pulmonology in the 21st century and the mark left by COVID-19. J Bras Pneumol 2022; 47:e20210499. [PMID: 35019058 PMCID: PMC8836645 DOI: 10.36416/1806-3756/e20210499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Marcelo Alcantara Holanda
- . Universidade Federal do Ceará - UFC - Fortaleza (CE) Brasil.,. Escola de Saúde Pública do Ceará Paulo Marcelo Martins Rodrigues, Fortaleza (CE) Brasil
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