title: Comparison of noninvasive ventilation by sequential use of mask and helmet versus mask in acute exacerbation of chronic obstructive pulmonary disease: a preliminary study.
abstract: BACKGROUND
  Noninvasive positive pressure ventilation (NPPV) using a face mask is the ventilatory mode of choice in selected patients experiencing acute exacerbation of chronic obstructive pulmonary disease (COPD). A high incidence of intolerance limits the use of this approach.
  
  
  OBJECTIVE
  To evaluate the sequential use of mask and helmet during NPPV in patients with severe exacerbation of COPD in order to reduce the intolerance to these devices.
  
  
  METHODS
  Fifty-three patients ventilated for the first 2 h with NPPV by mask were studied. If gas exchange and clinical status improved, they were randomized to continue on NPPV by mask or helmet. Physiological parameters were measured at admission, after the first 2 h on NPPV by mask, 4 h after randomization and at discharge. Need for intubation, ventilatory assistance, length of stay (LOS) and complications were recorded.
  
  
  RESULTS
  After the first 2 h of NPPV, gas exchange and clinical parameters improved in 40 patients. Four hours after randomization, PaCO(2) was lower in the mask group than in the helmet group. Nine patients in the mask group and 2 in the helmet group failed NPPV, 8 and 1, respectively, owing to intolerance. Time of noninvasive ventilation and LOS were lower in the mask than in the helmet group.
  
  
  CONCLUSIONS
  In patients with acute exacerbation of COPD and undergoing NPPV, the sequential use of a mask and helmet diminished the incidence of failure. Under the present experimental conditions, the use of a helmet increased LOS and the duration of artificial ventilation.
authors: Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste, Italy. v.antonaglia@libero.it
authors: Vittorio
authors: V
authors: Antonaglia
authors: Massimo
authors: M
authors: Ferluga
authors: Rossella
authors: R
authors: Molino
authors: Umberto
authors: U
authors: Lucangelo
authors: Alberto
authors: A
authors: Peratoner
authors: Erik
authors: E
authors: Roman-Pognuz
authors: Loredana
authors: L
authors: De Simoni
authors: Walter A
authors: WA
authors: Zin
mesh_terms: D000368:Aged; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D007902:Length of Stay; D008297:Male; D008397:Masks; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control