Helmet continuous positive airway pressure for patients' transport using a single oxygen cylinder: A bench study

Background: Continuous positive airway pressure (CPAP) is frequently used to treat patients with acute respiratory failure in out-of-hospital settings. Compared to a facemask, the helmet has many advantages for the patient but requires a minimum gas flow of 60 L/min to avoid CO2 rebreathing. The aim of the present bench study was to evaluate the performance of four Venturi devices, connected to a single oxygen cylinder, in delivering helmet-CPAP with clinically relevant gas flow, fraction of inspired oxygen (FiO(2))(,) and positive end-expiratory pressure (PEEP) values. Methods: Three double-inlet Venturi systems (EasyVent, Ventuplus, Compact-HAR) were connected to full 5-L oxygen cylinders using a double flowmeter, and their oxygen requirements to reach different setups (flow 60-80 L/min; FiO(2) 0.4-0.5-0.6, PEEP 7.5-10-12.5 cmH(2)O) were tested. The fourth Venturi system (O2-MAX) was directly attached to the tank, and the flow and FiO(2) delivered at preset FiO(2) 0.3 and 0.6 were recorded. The runtime of the cylinder was assessed. Results: EasyVent, Ventuplus, and O2-MAX were able to deliver helmet-CPAP with clinically useful setups when connected to a single oxygen cylinder, while Compact-HAR did not. The runtime of the cylinders ranged between 28 and 60 minutes according to the preset flow and FiO(2). The delivered gas flow decreased slowly and linearly with the drop in cylinder pressure until its exhaustion. Conclusions: Helmet-CPAP might be provided using portable Venturi systems connected to an oxygen cylinder, but not all of them are able to deliver it. The use of a double flowmeter allows delivery of both high flow and high FiO(2) when double-inlet Venturi systems are used. Due to the flow drop observed during the cylinder consumption, a flow >60 L/min should be set when helmet-CPAP is started. Considering the flow drop phenomenon, the estimated duration of the tank runtime can be used with a margin of safety when planning patient transport.