Helmets for CPAP

Giacomo Bellani, MD, PhD University of Milan-Bicocca

A.O. San Gerardo Monza (Italy)

Conflicts of Interest

INSTITUTIONAL:

Research grants from:

– Draeger

– Maquet

– Airway Medix

– Chiesi Farmaceutica, SPA

Patent transferal to: Draeger

PERSONAL

Consultancy fee from: Draeger

PEEPvalve

Gas Inlet

Helmets for CPAP

Giacomo Bellani, MD, PhD University of Milan-Bicocca

A.O. San Gerardo Monza (Italy)

CPAP

JAMA 2005 (Dec); 294: 3124-3130

Acute Cardiogenic PE

F = 90 l/min F = 90 l/min

Paw

Pat flow

Airway flow

F = 40 l/min F = 90 l/min

Paw

Pat flow

Airway flow

F = 50 l/min

F = 90 l/min

Paw

Pat flow

Airway flow

F = 120 l/min

F = 210 l/min F = 120 l/min

F = 90 l/min

Expiratory valve resistance

5

7

9

11

13

15

17

19

30 40 50 60 70 80 90 100 110 120

P in

sid

e h

elm

et (

cmH

2O

)

Gas Flow (L/min)

10

Isgrò S et al., Minerva anestesiol 2003

Keep airway pressure stable

High fresh gas flow rates

Low FiO2 (venturi)

High O2

consumption

Expiratory workload

Humidification

Compliance

Then, what do we need?

Time

Pressure

Ppl

Paw

WOB imposed by circuit

What does reservoir do?

Helmet volume (L) 13 22 17

Helmet

compliance

(ml/cmH2O)

PEEP 5 726 1131 826

PEEP 10 456 666 496

PEEP 15 354 503 385

Helmet Hose

Resistance

(cmH2O/Lxsec -1)

0.48 0.6 0.24

PN500 - Harol CaStar - StarMed 4Vent - Rüsh

Figure 2: effect of different CPAP levels on FRC during CPAPH (left side) and CPAPM (right side) in each subject. Each point

represent mean ± sd of FRC between different gas flow rates. Dotted lines refer to subjects with evidence of expiratory muscle

contraction.

* effect of CPAP levels during CPAPH p<0.05; # effect of CPAP levels during CPAPM p<0.05.

0

500

1000

1500

2000

5 10 15 5 10 15

Helmet Mask

F

RC

(m

l)

* #

CPAP levels (cmH2O)

FRC changes

Patroniti N., Foti G., Pesenti A. et al. ICM (2003). 29: 1680-87

Bias Flow in the Head Tent MUST be > 30 L/min.

0

2

4

6

8

10

12

14

20 30 40 50

Bias Flow (L/min)

PC

O2

ins

p (

mm

Hg

)

0

200

400

600

800

1000

1200

TV

(m

l)

PCO2insp.

TV

Head Helmet versus Face Mask for Non Invasive CPAP : a physiological study

Patroniti N., Foti G., Manfio A., Coppo A., Bellani G., Pesenti A.

ICM September 2003 29:1680-1687

0

2

4

6

8

10

12

14

16

0

5

10

15

20

25

30

35

40

45

50

Face Mask 60 L/min 10 L/min 30 L/min Ventilator

PetCO2

PiCO2 (m

mH

g)

VE (

L/m

in )

Taccone P. et al. Crit Care Med (2004)

Conclusion

Helmet CPAP is an effective way to provide noninvasive CPAP

As effective as face mask (less O2 consuption, higher FiO2)

Some data suggest a better comfort than face mask

Rebreathing has to be taken into account (avoid the use of a MV to provide CPAP)

Thank you!