WHO Recommends Helmet Use for Non-Invasive Ventilation in New Guidelines!
Updated: Sep 26, 2022
The 2022 World Health Organization (WHO) Clinical Care for Severe Acute Respiratory Infection Toolkit includes helmet-based therapies, providing valuable information for clinicians who wish to use helmets to treat patients.
“It’s exciting to see helmets in the toolkit”, said Aurika Savickaite, MSN, RN, founder of helmetbasedventilation.com. She aimed at raising awareness and safe use of helmets in the treatment of severe respiratory illnesses. Savickaite designed a helmet-based ventilation course, which is now available for free, to help clinicians around the world to use helmets safely and effectively.
While developing complete training to ensure the best patient outcomes, Savickaite has worked with experts in the field of helmet-based ventilation since the beginning of the pandemic. The experts include Dr. Bhakti Patel, Dr. John P. Kress, Dr. Jesse Hall, Dr. Maurizio Cereda, and Dr. Giacomo Bellani. Their feedback and suggestions were reflected not just in the training course but also in recommendations for the toolkit to WHO which was introduced at a June 21 webinar.
The helmet-based ventilation experts want clinicians to understand the difference between helmet NIV (Non-Invasive Ventilation) and helmet CPAP (Continuous Positive Airway Pressure) therapies, Savickaite said. While both can be used for patients in respiratory distress, they are different treatments, she said.
“What is very important to understand is that when the “helmet NIV” term is mentioned in studies - it means that the patient is receiving bilevel ventilation, and you have to set inspiratory and expiratory pressures. Where with helmet CPAP, you’re using CPAP therapy, where you only have to set expiratory pressure and the flow,” she said.
Many studies showed that helmet NIV has better patient outcomes in comparison to other interfaces, but the Helmet CPAP therapy success rates are even greater, she said, this is because they are two different therapies for two different patient populations.
“What is happening, is that when clinicians read Helmet NIV studies, they assume that researchers used the helmet CPAP therapy,” she said. “We have to pay attention to the details, learn about settings that were used and why these settings were used during the medical trial.”
As an example, the Helmet CPAP is used early as a first-line intervention, while helmet NIV is usually used for sicker patients who need more support for ventilation, this is why we cannot compare apples to oranges when we talk about helmets, she added.
Mrs. Savickaite and the helmet-based ventilation team warn that if the face-mask specific CPAP or BIPAP settings are used for helmet patients, there will be carbon dioxide (CO2) rebreathing and a failure of noninvasive positive-pressure ventilation (NIPPV). They strongly advise clinicians to have separate instructions for helmet interface which can be found in the training course.
Thank you to WHO leaders and clinical experts for including the helmet interface in the new toolkit and spreading awareness about this proven to be safe and advanced technology.
On September 15th WHO released “Clinical management of COVID-19: living guideline” which includes helmet-based ventilation research studies and recommendations regarding optimal interface for NIV.
“The Guideline Development Group (GDG) chose not to make a recommendation regarding optimal interface for CPAP, whether helmet or face mask, given the lack of direct data available for the comparison. The choice between interfaces should be guided by clinician experience, availability, and patent comfort.”
I’m so thankful to the team of helmet-based ventilation experts Andrea Coppadoro, Elisabetta Zago, Fabio Pavan, Giuseppe Foti, and Giacomo Bellani for their time and expertise in this field. Their 2021 review article “The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings” is listed as additional information for helmet interface users in the WHO guideline.