Helmets for CPAP - Critical Care Canada Forum

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Helmets for CPAP - Critical Care Canada Forum
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
Gas Inlet
PEEPvalve
Helmets for CPAP
Giacomo Bellani, MD, PhD
University of Milan-Bicocca
A.O. San Gerardo
Monza (Italy)
Acute Cardiogenic PE
JAMA 2005 (Dec); 294: 3124-3130
F = 90 l/min
Paw
Airway
flow
Pat flow
F = 90 l/min
F = 90 l/min
F = 50 l/min
Paw
Airway
flow
Pat flow
F = 40 l/min
F = 90 l/min
F = 120 l/min
Paw
Airway
flow
Pat flow
F = 120 l/min
F = 90 l/min
F = 210 l/min
Expiratory valve resistance
19
P inside helmet (cmH2O)
17
15
1013
11
9
7
5
30
40
50
Isgrò S et al., Minerva anestesiol 2003
60
70
80
90
Gas Flow (L/min)
100
110
120
Keep airway pressure stable
High fresh gas flow rates
Low FiO2
(venturi)
High O2
consumption
Expiratory
workload
Humidification
Then, what do we need?
Compliance
What does reservoir do?
WOB imposed by circuit
Pressure
Paw
Ppl
Time
4Vent - Rüsh
PN500 - Harol
CaStar - StarMed
13
22
17
PEEP 5
726
1131
826
PEEP 10
456
666
496
PEEP 15
354
503
385
0.48
0.6
0.24
Helmet volume (L)
Helmet
compliance
(ml/cmH2O)
Helmet Hose
Resistance
(cmH2O/Lxsec -1)
FRC changes
2000
Helmet
FRC (ml)
1500
*
Mask
#
1000
500
0
5
10
15
5
10
15
CPAP levels (cmH2O)
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.
Patroniti N., Foti G., Pesenti A. et al. ICM (2003). 29: 1680-87
Bias Flow in the Head Tent
MUST be > 30 L/min.
14
1200
PCO2insp.
TV
10
1000
800
8
600
6
TV (ml)
PCO2insp (mmHg)
12
400
4
2
200
0
0
20
30
40
50
Bias Flow (L/min)
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
PetCO2
PiCO2
(mmHg)
50
45
40
35
30
25
20
15
10
5
0
16
VE (L/min )
14
12
10
8
6
4
2
0
Face Mask
60 L/min
30 L/min 10 L/min
Ventilator
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!

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