title: Oronasal mask versus helmet in acute hypercapnic respiratory failure.
abstract: The choice of the interface for noninvasive ventilation (NIV) is a key factor in NIV success. We hypothesised that a new helmet specifically design to improve performance in hypercapnic patients would be clinically equivalent to a standard oronasal mask. In a multicentre, short-term, physiological, randomised trial in chronic obstructive pulmonary disease patients facing an acute hypercapnic respiratory failure episode, we compared the changes in arterial blood gases (ABGs) and tolerance score obtained using the helmet or mask, and, as secondary end-points, dyspnoea, vital signs, early NIV discontinuation and rate of intubation. 80 patients were randomly assigned to receive NIV either with the helmet (n=39) or mask (n=41), using an intensive care unit ventilator. Compared with baseline, in the first 6 h, NIV improved ABGs, dyspnoea and respiratory rate (p<0.05) in both groups. Changes in ABGs and discomfort were similar with the two groups, while dyspnoea decreased more (p<0.005) using the mask. The rate of intubation and the need for interface change during the whole period of NIV were very low and not different between groups. The new helmet may be a valid alternative to a mask in improving ABGs and achieving a good tolerance during an episode of acute hypercapnic respiratory failure.
authors.affiliation: Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Pisani
authors.affiliation: Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mega
authors.affiliation: "Maggiore Della Carità" Hospital, Dept of Anesthesia and Intensive Care, Novara, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Vaschetto
authors.affiliation: Sant'Anna Hospital, ED, Como, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bellone
authors.affiliation: U.O. Pneumologia, Ospedale S. Donato, ASL 8, Arezzo, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scala
authors.affiliation: IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Emergency Medicine Dept, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cosentini
authors.affiliation: Public Health-Care, Dept of Epidemiology, Bologna, Italy.
authors.forename: Muriel
authors.initials: M
authors.lastname: Musti
authors.affiliation: Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Del Forno
authors.affiliation: Dept of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.affiliation: S. Orsola-Malpighi Hospital, Respiratory and Critical Care Unit, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Fasano
authors.affiliation: Dept of Translational Medicine, Eastern Piedmont University "A. Avogadro", Novara, Italy CRRF Mons. L. Novarese, Moncrivello, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Navalesi
authors.affiliation: Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy stefanava@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis / Q000379:methods; D057186:Comparative Effectiveness Research; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008397:Masks; D008991:Monitoring, Physiologic / Q000379:methods; D063087:Noninvasive Ventilation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D057240:Patient Preference / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome