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Helmet improves nCPAP for infants with respiratory failure

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Infants with mild acute respiratory failure better tolerate noninvasive continuous positive airway pressure (nCPAP) when it’s delivered through a helmet than with a conventional face mask, physicians in Italy have found. The helmet also improves oxygenation. [p 336]

Compared with nasal or whole-face masks, the helmet “allows the infant free movement of the head and interaction with environment while maintaining a good seal without compression of the face,” Dr. Giovanna Chidini, from Ospedale Maggiore Policlinico, Milan, and colleagues explain. [p335 c 1, 2/3 down]

To compare the feasibility of nCPAP delivery via the helmet (Castar Starmed, Mirandola, Italy) versus a facial mask (Respironics, Murrysville, Pennsylvania), the investigators conducted a single-center, randomized, cross-over trial involving 20 infants (ages 1-24 months) with clinical suspicion of pulmonary infection. [p 331 end c 1 and top c 2]

They received nCPAP by helmet and facial mask in random order for 90 minutes. Both trials were preceded by 30 minutes of unassisted spontaneous breathing through a Venturi mask. [p 331 c 2-3]

Sixteen patients failed treatment with the mask versus four treated with the helmet (p = 0.0002). The primary cause of this difference was intolerance, indicated by a COMFORT scale score > 26, which occurred in 13 patients during mask use versus 1 with the helmet (p = 0.0005). Twelve and four patients, respectively, required sedation during nCPAP. [p 333 end c 3 and p 334 c 1]

Compared with the mask, the helmet was also associated with significantly longer nCPAP application time, improved oxygenation, decreased respiratory rate and respiratory effort score, and lower systolic blood pressure and heart rate. [p 334 c 1 & 3]

“The helmet is a feasible alternative to the facial mask for delivery of nCPAP to infants with mild acute respiratory failure,” Dr. Chidini and associates conclude. [abstract]

Still, they warn clinicians that the helmet might increase the risk of CO2 rebreathing and loss of positive end-expiratory pressure. They therefore advise that “dedicated monitoring and alarm systems as well as a strict clinical control are mandatory for safe use of nCPAP by helmet, even in PICU settings.” [p 335 end c 2 and top c 3]

One of the authors has received grant funding from Starmed, but not for the current study. [p 336 end]

Reference:

Noninvasive Continuous Positive Airway Pressure in Acute Respiratory Failure: Helmet Versus Facial Mask

Pediatrics 2010;126:e330-e336.