title: Non-invasive ventilation delivered by conventional interfaces and helmet in the emergency department.
abstract: Non-invasive positive pressure ventilation is increasingly used as a first-line treatment for respiratory failure. Non-invasive positive pressure ventilation can reduce the complications of endotracheal intubation such as barotrauma, nosocomial infections and the need for sedation. Non-invasive positive pressure ventilation has been shown to reduce the rate of endotracheal intubation in acute cardiogenic pulmonary oedema (27%), in chronic obstructive pulmonary disease (21%), and in acute respiratory failure (17%). Non-invasive positive pressure ventilation can be successfully delivered in the emergency department or in the general ward. However, the criteria for interrupting non-invasive positive pressure ventilation must be stricter (i.e. failure to improve gas exchange within 30 min) than in the general ward. One of the main reasons for the failure of non-invasive positive pressure ventilation lies in the technical problems caused by the face mask. We recently developed a new interface, the 'helmet', to deliver non-invasive positive pressure ventilation. When using the helmet instead of a face mask an increase of 10 cm H(2)O of pressure support and a fast pressurization rate are recommended. In a lung model and in healthy individuals the helmet reduced inspiratory effort. In hypoxemic patients the helmet reduced the intubation rate and the incidence of face mask-related complications. We believe that the helmet can extend the application of non-invasive positive pressure ventilation in different categories of patients with respiratory failure.
authors.affiliation: Università degli Studi dell'Insubria, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Paolo
authors.initials: P
authors.lastname: Severgnini
authors.forename: Michele
authors.initials: M
authors.lastname: Aspesi
authors.forename: Chiara
authors.initials: C
authors.lastname: Gamberoni
authors.forename: Davide
authors.initials: D
authors.lastname: Chiumello
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fachinetti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Introzzi
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Chiaranda
mesh_terms: D002985:Clinical Protocols; D000075202:Contraindications; D004636:Emergency Service, Hospital; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods; D011312:Pressure; D012131:Respiratory Insufficiency / Q000628:therapy*; D015656:Respiratory Mechanics