Respiratory Therapist Offers Tips on how to Adopt and Implement Helmet NIV
Updated: Oct 7, 2020
WORCESTER, MASS -- Aurika Savickaite, co-founder of HelmetBasedVentilation.com refers to Rachel Carragher as a helmet “champion” and “pioneer.”
Early in the battle to fight COVID-19, Carragher, a respiratory therapist at UMass Memorial Health Care, Worcester, Mass. started researching the use of the noninvasive helmet. The physicians began looking at helmets in March, and after talking with doctors in Italy about their use, one of the anesthesiologists who works in critical care medicine, Dr. Rebecca Bauer, ordered and purchased the helmets on her own.
The helmets were delivered to Bauer in April, and she brought them to Carragher’s office.
“And that’s how I ended up with the helmets,” Rachel said.
“We all came together as a group to try to figure out the best way to utilize these helmets for the patients,” she said.
At that time, there was not a lot of information about the helmets, so the medical staff worked together to develop the best practices.
The BiPAP machine proved to be too loud, so they switched to the high-flow set-up for the nine patients they used the helmets on; the average age of the COVID-19 patients the helmets were used on was the mid-50s, Carragher said. The patients came up to the ICU from the emergency room. They were usually on high-flow and were switched to the helmet in the ICU.
They kept the flow to 80-85 L/min, Carragher said, which proved to be the most effective and most comfortable for the patients. Higher flows would prevent any fogginess, she added.
The team started to network with other physicians in Chicago and at UMass hospital.
Carragher’s medical director, Christine L. Bielick Kotkowski, who specializes in pulmonary disease, and Dr. Bauer were among those who were rallying for helmet use.
“They were true supporters of the helmet with me and helped me on a physician level to get buy-in from the physicians,” Carragher said.
One of the trial patients was a 56-year-old male in severe distress – and it was his initial success that impressed many of the doctors and nurses.
“When we put (the helmet) on … he turned the corner so quickly, he was actually sitting in a chair, facetiming his family, he was doing extremely well with the helmet,” Carragher said.
“We got a lot of buy-in from the nurses because they actually saw how well he improved, so that was great that the nurses in the ICU, actually witnessed how well this individual turned around,” she said.
Not all patients are candidates for the helmet, as some can’t tolerate the hood. The patients in the trial averaged about three to four days, and some did need to be intubated, as well, Carragher said.
The trial patients were not prone, Carragher said.
“We wanted to, we just weren’t at that time, doing that,” she said.
Some patients received low sedation to help their comfort level, she added. Letting patients get their nutrients also helps with comfort.
The helmet requires work and is time-consuming in the beginning, and education is essential. Some of the early challenges including feeding patients and making sure the helmet was fit correctly.
“You have to learn you have to go over those bumps before you start to feel very comfortable using the helmet,” Savickaite said, referring to the protocols shared on the HelmetBasedVentialation.com website.
Medical personnel should also watch for pressure injuries around the arms and other areas, Carragher said.
“And then just really be careful around the patient’s neck,” she said, adding they used a DuoDERM® dressing for a patient who used a helmet for a whole week.
The dressing helps seal the helmet as well, and can be more comfortable, Savickaite added.
With COVID cases currently down in her area, Carragher said they will be able to regroup and learn more about the helmet, and different ways the helmet can be used with patients who have respiratory needs.
Carragher shared an important feature of the "Sea-Long" helmet.
“There is an inspiratory side (with a one-way valve) and an expiratory side,” she said. “That’s really important to know.”
Patient education is important, and is an ongoing process, Savickaite said.
In conclusion, Carragher said that it is important to have a helmet “champion” on the team.
“You need a ‘superuser’; you need someone who is passionate and is willing to try new things,” Carragher said, suggesting someone in the anesthesiology department. “You need someone very clinically strong and who is willing to devote time to put something in place and then be able to educate your nursing staff, your physician staff, your respiratory therapists."
“It’s lots of work, but hopefully the outcome is that these patients aren’t getting intubated,” Carragher said.