Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: an Observational Study During the COVID-19 Outbreak

Overview

Journal Crit Care

Specialty Critical Care

Date 2021 Feb 25

PMID 33627169

Citations 39

Authors

Andrea Coppadoro

Annalisa Benini

Robert Fruscio

Luisa Verga

Paolo Mazzola

Giuseppe Bellelli

Marco Carbone

Giacomo Mulinacci

Alessandro Soria

Beatrice Noe

Eduardo Beck

Riccardo Di Sciacca

Davide Ippolito

Giuseppe Citerio

Maria Grazia Valsecchi

Andrea Biondi

Alberto Pesci

Paolo Bonfanti

Davide Gaudesi

Giacomo Bellani

Giuseppe Foti

Affiliations

Soon will be listed here.

Abstract

Background: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).

Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients' data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death.

Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO/FiO ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO/FiO during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards.

Conclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.

Trial Registration: NCT04424992.

Citing Articles

'Do-not-intubate' orders in patients assisted by noninvasive respiratory support for acute hypoxaemic failure caused by coronavirus disease 2019; a systematic review and meta-analysis.

Cammarota G, Esposito T, Simonte R, Messina A, Cecconi M, Vaschetto R Eur J Anaesthesiol Intensive Care. 2025; 2(1):e0018.

PMID: 39916762 PMC: 11783619. DOI: 10.1097/EA9.0000000000000018.

CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU.

Matos I, Tomaz B, Sales M, Gomes G, Brazil Viana Junior A, Goncalves M J Bras Pneumol. 2024; 50(5):e20240299.

PMID: 39661843 PMC: 11601069. DOI: 10.36416/1806-3756/e20240299.

Acceptance and Tolerability of Helmet CPAP in Pediatric Bronchiolitis and Pneumonia: A Feasibility Study.

Smith M, Gray M, Wilson P J Pediatr Intensive Care. 2024; 13(3):296-302.

PMID: 39629153 PMC: 11379528. DOI: 10.1055/s-0042-1760634.

Helmet Continuous Positive Airway Pressure for Acute Bronchiolitis Respiratory Failure in a Pediatric Ward: Is It a Replicable Experience?.

Musolino A, Persia S, Supino M, Stoppa F, Rotondi Aufiero L, Nacca R Children (Basel). 2024; 11(11).

PMID: 39594847 PMC: 11592809. DOI: 10.3390/children11111273.

Oxygenation indices and early prediction of outcome in hypoxemic patients with COVID-19 pneumonia requiring noninvasive respiratory support in pulmonary intermediate care unit.

Scala R, Renda T, Bambina S, Guidelli L, Arniani S, Carrassa L Pneumonia (Nathan). 2024; 16(1):22.

PMID: 39582005 PMC: 11587655. DOI: 10.1186/s41479-024-00145-9.

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