Helmet-based ventilation isn’t a new technology, but how it’s helping innovate patient care in COVID and non-COVID times was the focus of a Medicine For Good podcast.
Dr. Julieta Gabiola, a clinical professor of medicine at Stanford University and the president and CEO of ABCs for Global Health, hosts the podcast, Simple Solutions to Medical Challenges: The Wonder That Is Helmet-Based Positive Pressure Ventilation. She interviewed Aurika Savickaite, MSN, RN, co-founder of www.helmetbasedventilation.com, a website aimed at increasing awareness and safe use of helmets to treat patients with severe respiratory illnesses.
“Every innovation leads to a new thing, but not every new thing is an innovation,” Gabiola said. “Some innovations are old but may have new creative applications and may even provide practical solutions, for that matter."
“Some innovations may be very simple but may have powerful impact or may lead to meaningful outcomes. Helmet-based ventilation is one of these innovations, which offers practical solutions during COVID or non-COVID times,” Gabiola said.
Savickaite participated in one of the first studies of helmets in the United States by Bhakti Patel, MD, and to share those positive results with her colleagues and professors she wrote her capstone paper about it back in 2014.
“You know, when you come to the US, and you see all this technology that is available in ICUs, all this high-tech equipment that is just so fascinating, I love learning about it. And it was so exciting to be there with the team and to bring more innovation and high-tech. And then one day, when I saw the helmet, I was thinking, ‘Wait for a second, there are no buttons to push, there is nothing super fancy about the helmet. How is that going to work?’ So, helmet looked a little bit funny. Still when I saw the results when I saw these patients who were able to take a breath, rest, and who were able to go over that most difficult stage in their disease when their ventilator was right next to their bed, and we were ready to intubate the patient any moment,” Savickaite said.
“It gives you that long-term, non-interrupted noninvasive ventilation or CPAP (continuous positive airway pressure) therapy for the patient,” Savickaite said. “It is very comfortable to wear. Nothing touches patients' faces so they can receive pain-free therapy.
“If needed, you can increase the PEEP (positive end-expiratory pressure), wherewith the face mask there are many limitations. If you are using the higher PEEP, you’ll notice air leaks around the face mask, to prevent it - you have to press the mask even harder into the face, and then the skin breakdown will begin,” she said.
Helmets offer a universal fit. It doesn’t matter if you have facial hair, trauma to the face, or missing teeth, the helmet fits around the neck with a soft silicone seal that prevents air leaks and improves infection control.
The patient can cough, speak, drink, eat, see, hear and have suction and oral care while wearing a helmet. The helmet shouldn’t get clouded or fogged, because the air doesn’t need humidification or to be heated. Helmets help prevent aspiration from emesis because the air is not pushing stomach contents into your lungs.
There’s nothing touching the patient’s face to cause anxiety. They fit all sizes, from pediatric to obese patients. It feels like wearing a loose turtleneck, Savickaite said, noting clinicians should try on the helmet first to give confidence to their patients.
Savickaite said helmets should be used as the first line of care – not as a last resort. Helmets can be a diagnostic tool, she added. “You will know if a patient is going to do well” within 30 to 60 minutes of starting helmet-based ventilation. “If you don’t see improvement, you might need to have that patient intubated. Don’t delay intubation.”
Gabiola noted that helmets have been used in Italy for 20 years, and they worked well during the pandemic.
Italy used helmets to help deal with a shortage of ICU rooms and resources, including ventilators and nurses to operate the equipment, Savickaite said. They looked at ways to improve the technology they had to avoid ICU and intubation, even preadmission in the ambulance. “They saw how much patients improved and recovered,” she said. Today, many countries around the world are adopting helmet use.
Helmets are two to three times cheaper than face masks, Savickaite said, noting they cost between $125 and $200 per helmet. One helmet can be used for the same patient throughout an entire hospital stay – it doesn’t have to be changed.
“If we use helmets now instead of the face mask, we can save $449 million a year in the US. That calculation was done based on the Patel study that was way back before COVID, so I can see that we probably could save even more,” she added.
In Italy, clinicians will use one face mask for every three patients using helmets, Savickaite said. “They use the interface every day,” which is why there are a lot of studies about helmets from Italy.
One thing to note when reading studies, she said, is that helmet NIV, or noninvasive ventilation, is very different from helmet CPAP. NIV is bi-level ventilation, in which you set up pressure support and PEEP; CPAP provides helmet flow and PEEP. It’s important to know the difference when using helmets, she said.
Training is important for anyone new to helmet use to shorten the learning curve and ensure successful NIV with a helmet. She and a team of doctors involved in helmet-based ventilation created a free, four-hour online course to help nurses, respiratory therapists, and hospitalists learn how to use helmets for patients in respiratory distress.