Carlo Olivieri1, Federico Longhini, Tiziana Cena, Gianmaria Cammarota, Rosanna Vaschetto, Antonio Messina, Paola Berni, Corrado Magnani, Francesco Della Corte, Paolo Navalesi. 1. From Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy (C.O., G.C., R.V., A.M., P.B., F.D.C.); Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy (F.L., P.N.); the Medical Statistics and Cancer Epidemiology Unit, Eastern Piedmont University "A. Avogadro," Novara, Italy (T.C., C.M.); the Department of Translational Medicine, Eastern Piedmont University "A. Avogadro," Novara, Italy (F.D.C., P.N.); and CRRF Mons. L. Novarese, Moncrivello (VC), Italy (P.N.).
Abstract
BACKGROUND: The helmet is a well-tolerated interface for noninvasive ventilation, although it is associated with poor patient-ventilator interaction. A new helmet (NH) has proven to attenuate this limitation of the standard helmet (SH) in both bench study and healthy volunteers. The authors compared a NH and a SH in intensive care unit patients receiving noninvasive ventilation for prevention of postextubation respiratory failure; both helmets were also compared with the endotracheal tube in place before extubation. METHODS:Fourteen patients underwent 30-min trials in pressure support during invasive ventilation and then with a SH and a NH in a random order. The authors measured comfort, triggering delays, rates of pressurization (airway pressure-time product [PTP] of the first 300 [PTP(300-index)] and 500 [PTP(500-index)] ms from the onset of effort, and the first 200 ms from the onset of insufflation [PTP200]), time of synchrony between effort and assistance (Time(synch)/Ti(neu)), respiratory drive and frequency, arterial blood gases (ABGs), and rate of asynchrony. RESULTS: Compared with SH, NH improved comfort (5.5 [5.0 to 6.0] vs. 8.0 [7.8 to 8.0]), respectively, P < 0.001), inspiratory trigger delay (0.31 [0.22 to 0.43] vs. 0.25 [0.18 to 0.31] s, P = 0.007), and pressurization (PTP(300-index): 0.8 [0.1 to 1.8] vs. 2.7 [7.1 to 10.0]%; PTP(500-index): 4.8 [2.5 to 9.9] vs. 27.3 [16.2 to 34.8]%; PTP200: 13.6 [10.1 to 19.6] vs. 30.4 [24.9 to 38.4] cm H2O/s, P < 0.01 for all comparisons) and Time(synch)/Ti(neu) (0.64 [0.48 to 0.72] vs. 0.71 [0.61 to 0.81], P = 0.007). Respiratory drive and frequency, ABGs, and rate of asynchrony were not different between helmets. Endotracheal tube outperformed both helmets with respect to all variables, except for respiratory rate, ABGs, and asynchronies. CONCLUSIONS: Compared with a SH, a NH improved comfort and patient-ventilator interaction.
RCT Entities:
BACKGROUND: The helmet is a well-tolerated interface for noninvasive ventilation, although it is associated with poor patient-ventilator interaction. A new helmet (NH) has proven to attenuate this limitation of the standard helmet (SH) in both bench study and healthy volunteers. The authors compared a NH and a SH in intensive care unit patients receiving noninvasive ventilation for prevention of postextubation respiratory failure; both helmets were also compared with the endotracheal tube in place before extubation. METHODS: Fourteen patients underwent 30-min trials in pressure support during invasive ventilation and then with a SH and a NH in a random order. The authors measured comfort, triggering delays, rates of pressurization (airway pressure-time product [PTP] of the first 300 [PTP(300-index)] and 500 [PTP(500-index)] ms from the onset of effort, and the first 200 ms from the onset of insufflation [PTP200]), time of synchrony between effort and assistance (Time(synch)/Ti(neu)), respiratory drive and frequency, arterial blood gases (ABGs), and rate of asynchrony. RESULTS: Compared with SH, NH improved comfort (5.5 [5.0 to 6.0] vs. 8.0 [7.8 to 8.0]), respectively, P < 0.001), inspiratory trigger delay (0.31 [0.22 to 0.43] vs. 0.25 [0.18 to 0.31] s, P = 0.007), and pressurization (PTP(300-index): 0.8 [0.1 to 1.8] vs. 2.7 [7.1 to 10.0]%; PTP(500-index): 4.8 [2.5 to 9.9] vs. 27.3 [16.2 to 34.8]%; PTP200: 13.6 [10.1 to 19.6] vs. 30.4 [24.9 to 38.4] cm H2O/s, P < 0.01 for all comparisons) and Time(synch)/Ti(neu) (0.64 [0.48 to 0.72] vs. 0.71 [0.61 to 0.81], P = 0.007). Respiratory drive and frequency, ABGs, and rate of asynchrony were not different between helmets. Endotracheal tube outperformed both helmets with respect to all variables, except for respiratory rate, ABGs, and asynchronies. CONCLUSIONS: Compared with a SH, a NH improved comfort and patient-ventilator interaction.
Authors: Federico Longhini; Davide Colombo; Lara Pisani; Francesco Idone; Pan Chun; Jonne Doorduin; Liu Ling; Moreno Alemani; Andrea Bruni; Jin Zhaochen; Yu Tao; Weihua Lu; Eugenio Garofalo; Luca Carenzo; Salvatore Maurizio Maggiore; Haibo Qiu; Leo Heunks; Massimo Antonelli; Stefano Nava; Paolo Navalesi Journal: ERJ Open Res Date: 2017-10-04
Authors: F Longhini; A Bruni; E Garofalo; P Navalesi; G Grasselli; R Cosentini; G Foti; A Mattei; M Ippolito; G Accurso; F Vitale; A Cortegiani; C Gregoretti Journal: Pulmonology Date: 2020-04-30