Aniket S Rali, Christopher Howard, Rachel Miller, Christopher K Morgan, Dennis Mejia, John Sabo, James P Herlihy, Sunjay R Devarajan
{"title":"Helmet CPAP revisited in COVID-19 pneumonia: A case series.","authors":"Aniket S Rali, Christopher Howard, Rachel Miller, Christopher K Morgan, Dennis Mejia, John Sabo, James P Herlihy, Sunjay R Devarajan","doi":"10.29390/cjrt-2020-019","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients.</p><p><strong>Case and outcomes: </strong>This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease.</p><p><strong>Discussion: </strong>NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population.</p><p><strong>Conclusion: </strong>Helmet NIPPV is a feasible therapy to manage COVID-19 patients.</p>","PeriodicalId":39373,"journal":{"name":"Canadian Journal of Respiratory Therapy","volume":"56 ","pages":"32-34"},"PeriodicalIF":1.1000,"publicationDate":"2020-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/20/cjrt-2020-019.PMC7427972.pdf","citationCount":"10","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Respiratory Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.29390/cjrt-2020-019","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/1/1 0:00:00","PubModel":"eCollection","JCR":"0","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 10
Abstract
Introduction: Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients.
Case and outcomes: This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease.
Discussion: NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population.
Conclusion: Helmet NIPPV is a feasible therapy to manage COVID-19 patients.
期刊介绍：
The CJRT is published four times a year and represents the interests of respiratory therapists nationally and internationally. The CJRT has been redesigned to act as an educational dissemination tool. The CJRT encourages submission of original articles, papers, commentaries, case studies, literature reviews and directed reading papers. Submissions can be sent to Rita Hansen.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
