Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

被引：0
作者：
Antonio M Esquinas Rodriguez
Peter J Papadakos
Michele Carron
Roberto Cosentini
Davide Chiumello
机构：
[1] Avenida Marques de Los Velez s/n,Intensive Care Unit, Hospital Morales Meseguer
[2] University of Rochester,Department of Medicine, Anesthesiology and Intensive Care
[3] University of Padova,Gruppo NIMV UO Medicina d'Urgenza
[4] Fondazione IRCCS Ca' Granda,Anestesia, Rianimazione e Terapia del dolore
[5] Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico,undefined
来源：
Critical Care | / 17卷
关键词：
Continuous Positive Airway Pressure; Acute Respiratory Failure; Face Mask; Inspiratory Effort; Intubation Rate;
D O I：
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摘要：
Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO2 rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure.
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