title: Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask.
abstract: OBJECTIVE
  To assess noise exposure during noninvasive ventilation (NIV) with different types of interface (helmet, nasal, and facial masks).
  
  
  METHODS
  Ten "naive" healthy volunteers underwent NIV at pressure support levels of 10 and 15 cmH2O with: (a) helmet, (b) helmet equipped with HME filters at the junctions between the helmet and the inspiratory and expiratory branches of the respiratory circuit, (c) nasal mask, and (d) facial mask. Noise intensity was assessed with a sound level meter by placing a microphone near the right ear. Noise intensity and degree of discomfort were also assessed subjectively with a visual analogue scale.
  
  
  RESULTS
  Inside the helmet noise exceeded 100 dB. Noise intensity was poorly affected by pressure support level and unaffected by the presence of HME filters. During NIV with nasal or facial masks the noise did not exceed 70 dB (i.e., noise was not louder than the usual noise background in ICU). Subjective evaluation of noise intensity mirrored objective measurements; however, the presence of HME filters was associated with the feeling of less noise inside the helmet. The discomfort associated with the helmet did not significantly differ from that associated with the masks.
  
  
  CONCLUSIONS
  NIV helmet is associated with significantly greater noise than nasal and facial masks, but is as comfortable as masks, at least in the short term. Medium- and long-term exposure to loud noise may potentially impair ear function and increase the patient's discomfort.
authors.affiliation: Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy. f.cavaliere@rm.unicatt.it
authors.forename: Franco
authors.initials: F
authors.lastname: Cavaliere
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Roberta
authors.initials: R
authors.lastname: Costa
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Proietti
authors.forename: Antonino
authors.initials: A
authors.lastname: Sciuto
authors.forename: Simonetta
authors.initials: S
authors.lastname: Masieri
mesh_terms: D000328:Adult; D004781:Environmental Exposure / Q000032:analysis / Q000517:prevention & control*; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D009622:Noise / Q000517:prevention & control*; D014691:Ventilation