Log in | Register

Continuous positive airway pressure ventilation with helmet in infants under 1 year

Christophe Milési| Félicie Ferragu| Samir Jaber| Aline Rideau| Clémentine Combes| Stefan Matecki| Jacques Bourlet| Jean-Charles Picaud| Gilles Cambonie
Brief Report
Volume 36, Issue 9 / September , 2010

Pages 1592 - 1596

Abstract

Objective

To report the feasibility of helmet use in infants between 1 and 12 months old with acute respiratory failure.

Design and setting

Observations were made before and 2 h after helmet CPAP of 6 cm H2O. Failure was defined as recourse to intratracheal ventilation. Patient stabilization or improvement was defined as a variation <10% or a decrease >10% in one of the following: respiratory rate, inspired oxygen fraction, or capillary partial pressure of CO2. Tolerance was assessed by the pain and discomfort score, the systematic search for pressure sores, and the measurement of helmet humidity and noise level.

Results

Twenty-three infants with a median age of 5 (2–8) months were included. Helmet CPAP failed in two (9%) patients. Stability or improvement occurred in 16 (70%) patients. The pain and discomfort score was stable or improved in 22 (96%). Pressure sores were found in three (13%) infants. Humidity was 98% (98–99%) and fell to 40% (39–43%) after the humidifier was stopped. The noise level in the helmet was 81 (77–94) dB-SPL.

Conclusions

The helmet was a satisfactory interface for CPAP delivery in young infants in more than two-thirds of the cases. Pressure sores can be prevented by placing a cushion in the helmet. Caregivers need to take into account the high humidity and noise levels of this interface.

Keywords

References

  1. Bernet V, Hug M, Frey B (2005) Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 6:660–664
    • View reference on publisher's website
    • View reference on PubMed
  2. Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D (2006) Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 7:329–334
    • View reference on publisher's website
    • View reference on PubMed
  3. Mayordomo-Colunga J, Medina A, Rey C, Díaz JJ, Concha A, Los Arcos M, Menéndez S (2009) Predictive factors of non invasive ventilation failure in critically ill children: a prospective epidemiological study. Intensive Care Med 35:527–536
  4. Yañez LJ, Yunge M, Emilfork M, Lapadula M, Alcántara A, Fernández C, Lozano J, Contreras M, Conto L, Arevalo C, Gayan A, Hernández F, Pedraza M, Feddersen M, Bejares M, Morales M, Mallea F, Glasinovic M, Cavada G (2008) A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 9:484–489
    • View reference on publisher's website
    • View reference on PubMed
  5. Cambonie G, Milési C, Jaber S, Amsallem F, Barbotte E, Picaud JC, Matecki S (2008) Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis. Intensive Care Med 34:1865–1872
  6. Piastra M, Antonelli M, Chiaretti A, Polidori G, Polidori L, Conti G (2004) Treatment of acute respiratory failure by helmet-delivered non-invasive pressure support ventilation in children with acute leukemia: a pilot study. Intensive Care Med 30:472–476
  7. Codazzi D, Nacoti M, Passoni M, Bonanomi E, Sperti LR, Fumagalli R (2006) Continuous positive airway pressure with modified helmet for treatment of hypoxemic acute respiratory failure in infants and a preschool population: a feasibility study. Pediatr Crit Care Med 7:455–460
    • View reference on publisher's website
    • View reference on PubMed
  8. Chidini G, Calderini E, Pelosi P (2010) Treatment of acute hypoxemic respiratory failure with continuous positive airway pressure delivered by a new pediatric helmet in comparison with a standard full face mask: a prospective pilot study. Pediatr Crit Care Med. doi:10.1097/PPC.0b013e3181b8063b
  9. American Respiratory Care Foundation (1997) Consensus conference: noninvasive positive pressure ventilation. Respir Care 42:364–369
  10. Debillon T, Zupan V, Ravault N, Magny JF, Dehan M (2001) Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 85:F36–F41
    • View reference on publisher's website
    • View reference on PubMed
  11. Ankrom MA, Bennett RG, Sprigle S, Langemo D, Black JM, Berlowitz DR, Lyder CH, National Pressure Ulcer Advisory Panel (2005) Pressure-related deep tissue injury under intact skin and the current pressure ulcer staging systems. Adv Skin Wound Care 18:35–42
    • View reference on publisher's website
    • View reference on PubMed
  12. Liet JM, Millotte M, Tucci M et al (2005) Non invasive therapy with helium-oxygen for severe bronchiolitis. J Pediatr 147:812–817
    • View reference on publisher's website
    • View reference on PubMed
  13. Patroniti N, Foti G, Manfio A, Coppo A, Bellani G, Pesenti A (2003) Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study. Intensive Care Med 29:1680–1687
  14. Taccone P, Hess D, Caironi P, Bigatello LM (2004) Continuous positive airway pressure delivered with a “helmet”: effects on carbon dioxide rebreathing. Crit Care Med 32:2090–2096
    • View reference on publisher's website
    • View reference on PubMed
  15. Moerer O, Beck J, Brander L, Costa R, Quintel M, Slutsky AS, Brunet F, Sinderby C (2008) Subject–ventilator synchrony during neural versus pneumatically triggered non-invasive helmet ventilation. Intensive Care Med 34:1615–1623
  16. Antonelli M, Pennisi MA, Pelosi P, Gregoretti C, Squadrone V, Rocco M, Cecchini L, Chiumello D, Severgnini P, Proietti R, Navalesi P, Conti G (2004) Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study. Anesthesiology 100:16–24
    • View reference on publisher's website
    • View reference on PubMed
  17. Cavaliere F, Conti G, Costa R, Proietti R, Sciuto A, Masieri S (2004) Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask. Intensive Care Med 30:1755–1760
  18. Surenthiran SS, Wilbraham K, May J, Chant T, Emmerson AJ, Newton VE (2003) Noise levels within the ear and post-nasal space in neonates in intensive care. Arch Dis Child Fetal Neonatal Ed 88:F315–F318
    • View reference on publisher's website
    • View reference on PubMed
  19. American Academy of Pediatrics. Committee on Environmental Health (1997) Noise: a hazard for the fetus and newborn. Pediatrics 100:724–727
    • View reference on publisher's website
  20. Patuzzi R (1998) Exponential onset and recovery of temporary threshold shift after loud sound: evidence for long-term inactivation of mechano-electrical transduction channels. Hear Res 125:17–38
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement