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Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask

Davide Chiumello| Paolo Pelosi| Eleonora Carlesso| Paolo Severgnini| Michele Aspesi| Chiara Gamberoni| Massimo Antonelli| Giorgio Conti| Maurizio Chiaranda| Luciano Gattinoni
Original
Volume 29, Issue 10 / October , 2003

Pages 1671 - 1679

Abstract

Objective

This bench and human study compared large and small helmets with face mask (FM) for delivery of noninvasive positive pressure ventilation.

Design

A lung simulator was employed, and the human study involved six healthy subjects. We evaluated a continuous high-flow (CPAPHF), low flow (CPAPLF), ventilator (CPAPVENT) CPAP, and pressure support ventilation (PSV 10 and 20 cmH2O). In the human study we used CPAPHF, CPAPVENT, and PSV 5 cmH2O. PEEP was 5 cmH2O.

Measurements

In the bench study during CPAP we measured the negative airway pressure time product (areaCPAP), i.e., the area of airway pressure (Paw) under PEEP and during PSV the pressure airway time product (areaPSV), i.e., the area of Paw from onset to end of inspiratory flow. In the human study we measured the breathing pattern and work of breathing (WOB).

Results

In the bench study during CPAPLF the helmets had a lower areaCPAP than the FM, while during CPAPHF the three interfaces had similar areaCPAP. Using CPAPVENT and PSV the FM reduced areaCPAP and increased areaPSV compared to helmets. At 20 cmH2O of PSV using helmets areaPSV was similar to that obtained at 10 cmH2O of PSV using the FM. In human study using CPAPHF and CPAPVENT the tree interfaces had similar effects on breathing pattern and WOB, while using PSV the FM reduced WOB more than helmets.

Conclusions

During CPAPLF helmets were more efficient than FM, while during CPAPHF the three interfaces were comparable. Using CPAPVENT and PSV, FM was more efficient than helmets

Keywords

References

  1. International Consensus Conferences in Intensive Care Medicine (2001) Noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 163:283–291
    • View reference on PubMed
  2. Mehta S, Hill NS (2001) Noninvasive Ventilation. State of the Art. Am J Respir Crit Care Med 163:540–577
    • View reference on PubMed
  3. Carrey Z, Gottfried SB, Levy RD (1990) Ventilatory muscle support in respiratory failure with nasal positive pressure ventilation. Chest 97:150–158
    • View reference on PubMed
  4. Ambrosino N, Nava S, Bertone P, Fracchia C, Rampulla C (1992) Physiologic evaluation of pressure support ventilation by nasal mask in patients with stable COPD. Chest 101:385–391
    • View reference on PubMed
  5. Nava S, Ambrosino N, Rubini F, Fracchia C, Rampulla C, Torri G, Calderini E (1993) Effect of nasal pressure support ventilation and external PEEP on diaphragmatic activity in patients with severe stable COPD. Chest 103:143–150
    • View reference on PubMed
  6. Antonelli M, Conti G (2000) Noninvasive ventilation in intensive care unit patients. Curr Opin Crit Care 6:11–16
    • View reference on publisher's website
  7. Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S (2000) Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med 28:1785–1790
    • View reference on PubMed
  8. Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley E (1996) Non invasive positive pressure ventilation via face mask. First line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 109:179–193
    • View reference on PubMed
  9. Gregoretti C, Confalonieri M, Navalesi P, Squadrone V, Frigerio P, Beltrame F, Carbone G, Conti G, Gamna F, Nava F, Calderini E, Skrobik Y, Antonelli M (2002) Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study. Intensive Care Med 28:278–284
  10. Criner G, Travaline JM, Brennan KJ, Kreimer DT (1994) Efficacy of a new full face mask for noninvasive positive pressure ventilation. Chest 106:1109–1115
    • View reference on PubMed
  11. Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized prospective trial of non-invasive positive pressure ventilation in acute respiratory failure (1995) Am J Respir Crit Care Med 151:1799–1806
    • View reference on PubMed
  12. Foti G, Cazzaniga M, Villa F, Valle E, Sabato M, Apicella F, Casertelli V, Fontaba G, Rossi GP, Vesconi S, Pesenti A (1999) Out of hospital treatment of Acute pulmonary Edema (PE) by non invasive continuous positive airway pressure (CPAP): feasibility and efficacy. Intensive Care Med 112 [Suppl]:A431
  13. Antonelli M, Conti G, Pelosi P, Gregoretti C, Pennisi MA, Costa R, Severgnini P, Chiaranda M, Proietti R (2002) New treatment of acute hypoxemic respiratory failure: non invasive pressure support ventilation delivered by helmet. A pilot controlled trial. Crit Care Med 30:602–608
    • View reference on PubMed
  14. Pelosi P, Chiumello D, Calvi E, Taccone P, Bottino N, Panigada M, Cadringher P, Gattinoni L (2001) Effects of different continuous positive airway pressure devices and periodic hyperinflations on respiratory function. Crit Care Med 9:1683–1689
  15. Takeuchi M, Williams P, Hess D, Kacmarek RM (2002) Continuous positive airway pressure in new generation mechanical ventilators. Anesthesiology 96:162–172
    • View reference on PubMed
  16. Chatmongkolchart S, Williams P, Hess DR, Kacmarek RM (2001) Evaluation of inspiratory rise time and inspiration termination criteria in new generation mechanical ventilators: a lung model study. Respir Care 46:666–677
    • View reference on PubMed
  17. Chiumello D, Pelosi P, Croci M, Bigatello LM, Gattinoni L (2001) The effects of pressurization rate on breathing pattern, work of breathing, gas exchange and patient comfort in pressure support ventilation. Eur Respir J 18:107–114
    • View reference on PubMed
  18. Baydur A, Behrakis PK, Zin W, Jaeger MJ, Milic-Emily J (1982) A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 126:788–791
    • View reference on PubMed
  19. Aliverti A, Dellacà R, Pelosi P, Chiumello D, Pedotti A, Gattinoni L (2002) Optoelectronic plethysmography in intensive care patients. Am J Respir Crit Care Med 161:1546–1552
  20. Cala SJ, Kenyon CM, Ferrigno G, Carnevali P, Aliverti A, Pedotti A, Macklem PT, Rochester DF (1996) Chest wall and lung volume estimation by optical reflectance motion analysis. J Appl Physiol 81:2680–2689
    • View reference on PubMed
  21. Diehl JL, Atrous S, Touchard D, Lemaire F, Brochard L (1999) Changes in the work of breathing induced by tracheotomy in ventilator dependent patients. Am J Respir Crit Care Med 159:383–388
    • View reference on PubMed
  22. Lessard MR, Lofaso F, Brochard L (1995) Expiratory muscle activity increases intrinsic positive end expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 151:562–569
    • View reference on PubMed
  23. Kacmarek RM, Mang H, Barker N, Cycyk-Chapman MC (1994) Effects of disposable or interchangeable positive end-expiratory pressure valves on work of breathing during the application of continuous positive airway pressure. Crit Care Med 22:1219–1226
    • View reference on PubMed
  24. Braschi A, Iotti G, Locatelli A, Bellinzona G (1987) A continuous flow intermittent mandatory ventilation with continuous positive airway pressure circuit with high-compliance reservoir bag. Crit Care Med 15:947–950
    • View reference on PubMed
  25. Croci M, Pelosi P, Chiumello D (1996) Regulation of pressurization rate reduces inspiratory effort during pressure support ventilation: a bench study. Respir Care 41:888–884
  26. Tobin MJ, Jenouri G, Birvh S, Lind B, Gonzales H, Ahmed T, Sackner MA (1993) Effect of positive end-expiratory pressure on breathing patterns of normal subjects and intubated patients with respiratory failure. Crit Care Med 11:859–867

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