Treatment of acute respiratory failure by helmet-delivered non-invasive pressure support ventilation in children with acute leukemia: a pilot study

Objective: To evaluate the feasibility of non-invasive ventilation (NIV) through a new interface-the helmet-in the treatment of acute respiratory failure (ARF) in hematologic children. Design and setting: Observational, non-randomized report of four consecutive cases. Pediatric Intensive Care Unit in a university hospital. Patients and methods: Four consecutive females (aged 9-17 years) affected by acute leukemia (3 acute lymphocytic leukemia [ALL], 1 acute myeloid leukemia [AML]) and with hypoxemic ARF (defined by severe dyspnea at rest, respiratory rate >30 breaths/min, PaO2:FiO(2)<200 and active contraction of the accessory muscles). Pressure support ventilation was delivered via a helmet (CaStar, Starmed, Italy) by means of an ICU ventilator (Servo 300, Siemens Elema, Sweden). Results: We evaluated the effect of pressure support ventilation delivered by helmet on blood gases, respiratory rate, hemodynamics, patient tolerance, complication rate and outcome. An improvement of oxygenation was uniformly observed within the first 3 h after admission. The helmet was well tolerated by all children. No complication was observed. Two patients were discharged from the PICU in stable clinical conditions, whereas the remaining two children overcame the respiratory distress but had non-respiratory complications and eventually died. Conclusion: Non-invasive ventilation via the helmet can offer effective ventilatory support and improve gas exchange in the treatment of ARF in pediatric hematologic patients. As already shown in adults, NIV may decrease the risk of life-threatening complications associated with invasive mechanical ventilation (MV), also in children with hematologic malignancies; moreover, it offers the possibility of an earlier approach to respiratory failure in this patient subset.