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J Appl Physiol (June 16, 2005). doi:10.1152/japplphysiol.01363.2004
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Submitted on December 8, 2004
Accepted on May 11, 2005

EFFECTIVENESS OF MASK AND HELMET INTERFACES TO DELIVER NONINVASIVE VENTILATION IN A HUMAN MODEL OF RESISTIVE BREATHING

Fabrizio Racca1, Lorenzo Appendini2, Cesare Gregoretti3, Elisa Stra1, Antonio Patessio2, Claudio F. Donner2, and V. Marco Ranieri1*

1 Dipartimento di Anestesia e Rianimazione, Universita di Torino, Ospedale S.Giovanni Battista-Molinette, Torino, To, Italy
2 Divisione di Pneumologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, No, Italy
3 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera CTO-CRF-Maria-Adelaide, Torino, To, Italy

* To whom correspondence should be addressed. E-mail: marco.ranieri{at}unito.it.

The helmet, a transparent latex-free polyvinyl chloride cylinder linked by a metallic ring to a soft collar that seals the helmet around the neck, has been recently proposed as an effective alternative to conventional face-mask to deliver pressure support ventilation (PSV) during non invasive ventilation in patients with acute respiratory failure. We tested the hypothesis that mechanical characteristics of the helmet (large internal volume and high compliance) might impair patient-ventilator interactions as compared to standard face-mask. Breathing pattern, carbon dioxide clearance, indexes of inspiratory muscle effort and patient-ventilator asynchrony, and dyspnea were measured at different levels of PSV delivered by face-mask and helmet in six healthy volunteers before (load-off) and after (load-on) application of a linear resistor. During load-off, no differences in breathing pattern and inspiratory muscle effort were found. During load-on, the use of helmet to deliver pressure support increased inspiratory muscle effort and patient-ventilator asynchrony, worsened carbon dioxide clearance, and increased dyspnea compared to standard face-mask. Auto-cycled breaths accounted for 12% and 25% of the total minute ventilation and for 10% and 23% of the total inspiratory muscle effort during mask and helmet PSV, respectively. We conclude that PSV delivered by helmet interface is less effective in unloading inspiratory muscles compared to PSV delivered by standard face-mask. Other ventilatory assist modes should be tested to exploit to the most the potential benefits offered by the helmet.




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