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  • Helmet-Based Ventilation on "Exhale with Vitalograph" Podcast

    02/09/2022 Chicago Helmet-based ventilation offers advantages and benefits for patients and clinicians who use it. website founder Aurika Savickaite shared those advantages and benefits as a guest on Exhale with Vitalograph, a podcast series that explores respiratory care topics. “It’s the only universal device that can allow patients to breathe normally without causing any pain, facial skin ulcers, and necrosis,” Savickaite said, noting patients who use face masks have these issues. “And it also allows you to keep the therapy uninterrupted while still allowing patients to eat and drink. And that can increase better outcomes for these patients.” Some hospitals use helmets for ICU patients who require more than a day of non-invasive ventilation, she said – up to two weeks in Italy, for example. “So you imagine that the comfort for the patient is extremely important during that time because a lot of people will fail non-invasive ventilation due to the interface that is not comfortable,” she said. Savickaite took part in a three-year study at the University of Chicago (published in JAMA in 2016) in which immunocompromised patients with acute respiratory distress syndrome used helmet-based ventilation or face masks. The results found those using helmets were less likely to be intubated, and they spent fewer days in the hospital and ICU. Not every patient can use a face mask but the helmet interface has fewer contraindications. Some people have facial contours that make it difficult to fit a mask, for example, those who have no teeth, who are older, who have facial hair, or who have trauma or burns to the face, she said. Post-op patients can also use helmets. They are especially helpful for obese and overweight patients who will benefit from PEEP (positive end-expiratory pressure). Helmets also can be used to make the transition from the ventilator to extubation much easier, she said. For palliative care or do not intubate patients, helmets provide a comfortable alternative that can be used for a longer period of time, she said. Helmets can be used with patients who have pneumonia or ARDS, but they need to be watched closely, Savickaite warned, “because, as you know, delay in intubation is never a good outcome for anyone. So you always want to watch these patients closely and be ready to intubate if you see any signs of failure.” Clinicians can experience benefits from helmets, too. “Another feature that I love is that you can prevent the spread of infection into the environment. The helmet has a very good seal around the neck, all the air that is leaving the patient is filtered out from the helmet via the HEPA filter,” Savickaite said. “As a nurse who worked at the bedside for many years and saw many patients who use non-invasive ventilation, I also can say that helmets will reduce that workflow for the nurses and respiratory therapists,” Savickaite said. Medical staff are tired and burned out from working long hours, she noted. “If we can do something to help them lower that workload and still reach great outcomes for the patient, that’s a win-win situation.” Link to the podcast:

  • Helmets Used to Reduce Clinicians Workload and improve NIV

    01/17/2022 Chicago When Prof. Giacomo Bellani started clinical practice and research, he thought using helmets for patients in respiratory distress was standard practice because they are so common in Italy. After a few years, he realized that outside of Italy, and even in some regions in Italy, no one knew that helmets even existed. Bellani is an associate professor of Anesthesia and Critical Care Medicine of the University of Milan-Bicocca, in Monza, Italy, and a staff physician in the general Intensive Care Unit of San Gerardo Hospital. (Video of the interview is coming soon on our Youtube channel) Helmets are becoming better known, in part because of COVID-19, and in part because of people like Bellani, a proponent for them. He said helmets are “something I really believe works.” A superior tool Helmets are a tool to avoid intubation and, under several aspects, are superior to face masks for most patients, he said. They are part of the workflow – the first line of intervention and a reasonable way to manage patients early. But for patients who respond, helmets used early in treatment offer a longer bridge for other therapies to work. In his hospital, the ratio of patients who use helmets to face mask users is probably 2-3 helmets for 1 face mask. A “helmet is good when you don’t have the possibility to treat patients closely,” he said. “The reason why helmets picked up so much here in Italy, we used to have an outrageously small number of ICU beds,” he said. It forced clinicians to use helmets outside of the ICU in both hospital settings and ambulances. Clinicians who are new to helmets probably don’t know how much easier it is to set up a helmet than a face mask, he added. “Because many times, a face mask is a pain in the neck,” he said. “There are all these leaks and you cannot use it easily with the high flow -- you need a ventilator.” If people used helmets a few times, it would convince them they are really easy to use, he said. Difference between CPAP and NIV People often don’t understand that helmet NIV and helmet CPAP are two very different things. “Helmets are relatively easy to use with CPAP. You just need to have a good flow, and the PEEP valve will do the rest. I think that’s the key point to helmets. You drop the level of nursing assistance ... that you have to provide to the patient,” Bellani said. With CPAP ventilation, you can diagnose if the patient is PEEP responsive. As long as the gas flows, the valve is connected and nothing is disconnected, it’s really hard for something to go wrong with the helmet, he said. It still works, even with leaks. “You know, that’s robust,” he said. “NIV, it’s a different story,” he said. “You need to know how to set the ventilator. And if your goal is really to use it to reduce CO2, because the patient is hypercapnic, that’s not, honestly, as much as I love the helmet, that’s not the direction you want to go.” Bellani also has seen more patients -- even in Italy, the “helmet capital” -- being treated with a high-flow nasal cannula. Bellani helped develop a new Venturi flow generator, the EasyVEE, which allows the size of the port for ambient air to vary and provides continuous modulation of FiO2. He also helped patent a closed-circuit system to recirculate oxygen, remove carbon dioxide and drop oxygen use by 60 to 70 percent. It is able to flush a helmet for CPAP with 60 to 70 liters per minute using only 15 liters of oxygen. Presently, he’s working on a new flow generator, which may be available next year. Few problems with helmets A weakness of helmets, Bellani notes, is monitoring the helmet itself. Patients themselves are monitored, and if the helmet is disconnected from the airflow, there’s an anti-suffocation valve. The good news is that no patients have died from helmet failure to his knowledge. Devices are available now to monitor flow and pressure. The PEEP-Alert, approved by the FDA EUA, measures flow and pressure inside a helmet and sounds an alarm if it drops. Bellani is “very in favor of helmets, but if I was a detractor of helmets, I would see treatises of someone saying that’s too dangerous because you’re putting the patient’s head in a plastic bag, and there’s no alarm.” Bellani suggests doctors and nurses try the helmet themselves. Then, when patients ask, they can honestly say it wasn’t bad. “After they have it on their heads, they see it’s not that bad,” he said. “They breathe better.” Normally, patients find it’s easier to talk and look around. “It’s a little bit noisy (CPAP set up), but besides that, there’s nothing bad in it.” Cost savings for helmet use Many times, Bellani heard criticism that helmets are more expensive than face masks or high-flow nasal cannulas. Studies have shown better patient outcomes with helmet-based ventilation, fewer days in critical care, and less time hospitalized overall. During COVID, many patients in Italy were effectively managed outside of the ICU using helmets, which is a cost-saving that could be measured, he said. Additionally, there’s less nursing time required with a helmet than a face mask. Alberto Lucchini, a nursing coordinator in the general Intensive Care Unit of San Gerardo Hospital, has published papers about the nursing aspects of helmets. Hospitals that don’t use helmets lose the opportunity to start noninvasive ventilation early and to assess the patient to see if he or she is PEEP-responsive. Helmet CPAP can save money because there’s no ventilator, no knobs, no buttons, and no need for a respiratory therapist to be there at all times, Bellani said. “You don’t have to give the feeling that you’re trying to avoid intubation at any cost,” Bellani said. “That is not good either. If you try everything before intubating, you keep postponing the intubation for the patient, which is really bad for the patient.” Helmet use specifics US hospitals don’t have Venturi systems, but they do have a lot of BiPAP machines and ventilators. Helmet CPAP can’t use CPAP mode on a ventilator, though. Most ventilators now allow the use of a flow generator, Bellani said, such as with a high-flow nasal cannula. He suggests using a respiratory branch with a continuous flow system. If that’s not possible, he wouldn’t use CPAP mode, he said. “You have to get some pressure support, and you’re stuck with it. At this point, I would put a relatively low PEEP, let’s say 5, and pressure support of 8- 10, so flow is washing out CO2.” There’s also a problem with the flow that’s too high, he said. While you can go up to 80 to 90 liters for COVID, it’s not necessarily best for the patient, because the pressure is up during expiration. He suggests going to 60 liters. With helmet CPAP, he’s seen cases of self-induced lung injury. He suggests a device from the US, ExSpiron, for noninvasive monitoring of tidal volume. “I was skeptical,” he said, but “it’s very accurate.” Bellani commented on and its new online course for clinicians, noting this educational offering can help medical professionals understand better how to use helmets for their patients.

  • Is CPAP Therapy the Best for COVID Patients: What do We Know?

    11/11/2021 Chicago The past two years have brought unseen challenges for all of us, but especially for medical workers all around the world. The novel coronavirus (SARS-CoV-2) has come out of nowhere and placed a significant strain on the healthcare system. No one has known how to deal with the disease caused by a new virus and its related complications. Intensive care units (ICU) were under hard pressure at the very beginning of the pandemic and became crowded immediately. This led to reconsidering treatment strategies for COVID-19 patients and special attention to respiratory support. Pulmonary involvement is seen in a vast majority of persons affected by the SARS-CoV-2 virus. It varies from mild pneumonia to severe respiratory failure or acute respiratory distress syndrome (ARDS). Hospital mortality of patients with acute hypoxemic respiratory failure reaches 30% and the number of these patients increased dramatically during the COVID-19 pandemic. At the beginning of the COVID-19 era, most of these patients have been transferred to ICU and ventilated invasively. Consequently, intensive care units have faced a shortage of equipment as well as human resources thus clinicians and scientists started to search for new, less invasive, and more convenient treatment strategies. At the beginning of the pandemic non-invasive ventilation (NIV) methods have been poorly described and employed in the management of ARDS because of many controversies. At first, NIV strategies were thought to be associated with a higher risk of virus transmission and for safety reasons were avoided. However, with a separation of high-risk areas and personal protective equipment, the nosocomial spread of coronavirus was reduced. The other NIV-related concern is the generation of large tidal volume which may worsen lung damage and increase the risk for patients to develop self-inflicted lung injury. However, with the appropriate settings, this risk could be minimized, and it should not be a reason to avoid NIV. Over time number of patients affected by novel coronavirus was steadily growing and a new non-invasive approach towards hypoxemic COVID-19 patients has become a core treatment. To date, conventional oxygen therapy, high flow nasal oxygenation (HFNO), and continuous positive airway pressure (CPAP) oxygenation are more and more used in COVID-19 patients. The main goal of these NIV methods is to maintain adequate oxygenation and reduce the need for endotracheal intubation. Despite growing numbers of patients treated non-invasively efficacy and safety of different NIV methods were scarcely described. A clinical review by Crimi and colleagues discusses the advantages and disadvantages of HFNC compared with other NIV methods. The authors emphasize many clinical benefits of HFNC as its early application may reduce the need for tracheal intubation and treatment escalation. They also point out an easy-to-fit HFNC interface and an easier setup. However, only CPAP could maintain positive end-expiratory pressure (PEEP) which is important in COVID-19 affected patients with ARDS. In August 2021, the first results of a clinical trial called RECOVERY-RS were published. RECOVERY-RS is an open-label three-arm randomized controlled trial that has been performed across 48 sites in the UK with the aim to compare the effectiveness of different NIV methods. The biggest non-invasive respiratory support trial compared three commonly used respiratory interventions - CPAP, HFNO therapy, or conventional oxygen therapy. The primary outcome of this trial was mortality and tracheal intubation within 30 days. Over 1200 patients were included in this trial with respiratory failure caused by coronavirus disease. The results of the RECOVERY-RS trial have shown CPAP superiority over conventional oxygen therapy. The need for intubation and mortality was significantly lower in patients receiving CPAP than in those with conventional oxygen therapy (137/377 (36.3%) vs. 158/356 (44.4%), respectively). Interestingly, HFNO has not shown a significant advantage over conventional oxygenation. These findings support the idea that CPAP could be highly effective in the management of patients with COVID-19 pneumonia and acute hypoxemic respiratory failure. RECOVERY-RS trial has several limitations. First, the primary outcome was a quite heterogeneous composite of mortality and tracheal intubation within 30 days. Moreover, the decision to intubate patients was based on a personal physician’s opinion and experience which could obviously lead to biased results. Nevertheless, RECOVERY-RS findings are supported by Sakuraya and his colleagues. They published a meta-analysis of respiratory management in patients with acute hypoxemic respiratory failure. For the very first time, they compared the efficacy of NIV according to ventilation modes with HFNO, conventional oxygen therapy, and invasive mechanical ventilation. The primary outcome of this study was short-term mortality. They have found that CPAP was significantly associated with a lower risk of mortality (risk ratio, 0.55; 95% confidence interval, 0.31 – 0.95). Authors support the idea that CPAP may be the most effective option as the primary non-invasive respiratory management for patients with de novo acute hypoxemic respiratory failure. Several devices could be used to deliver CPAP including helmets. Importantly, helmet-based positive pressure ventilation was significantly associated with a lower risk of death and endotracheal intubation compared with conventional oxygen therapy, HFNO, and face mask NIV among patients with acute respiratory failure in a meta-analysis published in JAMA. Most of the study patients used helmet CPAP therapy and this probably contributed to the superiority of helmet-based ventilation in this meta-analysis. Despite helmet-based ventilation drawbacks, such as large interface volume and dead space it remains an important strategy to deliver CPAP and provide higher levels of PEEP. To sum up, after almost two years of COVID-19 pandemic we still have more questions than answers. Despite a highly effective vaccine against SARS-CoV-2, we are still facing everyday challenges in the management of COVID-19 patients. Respiratory support remains a cornerstone in the treatment strategy with the emphasis on non or less invasive, safe, and effective methods. To date, more and more studies prove the CPAP superiority over other NIV methods in terms of mortality and tracheal intubation. However, more further studies are needed to confirm this evidence. Reference: 1. Crimi C, Pierucci P, Renda T, Pisani L, Carlucci A. High-Flow Nasal Cannula and COVID-19: A Clinical Review. Respir Care. Published online September 14, 2022. doi:10.4187/respcare.09056 2. Sakuraya M, Okano H, Masuyama T, Kimata S, Hokari S. Efficacy of Non-Invasive and Invasive Respiratory Managements in Adult Patients with Acute Hypoxaemic Respiratory Failure: A Systematic Review and Network Meta-Analysis. In Review; 2021. doi:10.21203/ 3. Ferreyro BL, Angriman F, Munshi L, et al. Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure. JAMA. 2020;324(1):1-12. doi:10.1001/jama.2020.9524 4. RECOVERY RS: CPAP vs HFNO vs Conventional Oxygen Therapy in COVID-19. REBEL EM - Emergency Medicine Blog. Published September 13, 2021. Accessed October 25, 2021. 5. JC: Non-invasive ventilation for COVID 19 patients. The Recovery RS trial. St Emlyn’s. St.Emlyn’s. Published August 20, 2021. Accessed October 25, 2021.

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  • Helmet Based Ventilation for COVID-19 | Non-Invasive Ventilation, NIV

    Research Infographics Medical Guidelines Helmet-based Ventilation Online Course is Now Live! Learn More Helmet-based positive pressure ventilation is a solution for COVID-19 treatment Our goal is to provide useful information to clinicians about helmet use for noninvasive ventilation in patients who have respiratory distress as a complication of the COVID-19 virus. Helmet-based positive pressure ventilation saves lives, shortens ICU stays for patients who need mechanical ventilation and can be used on step-down units. In addition, it can be used for other patients who have different causes of respiratory distress. Latest Articles Helmet-Based Ventilation on "Exhale with Vitalograph" Podcast 51 Helmets Used to Reduce Clinicians Workload and improve NIV 120 Is CPAP Therapy the Best for COVID Patients: What do We Know? 146 DIMAR Helmets Support Varied Use for COVID and Non-COVID Patients 432 Helmet Manufacturer Harol - NIV Experts for over 40 Years 89 Solutions to Medical Challenges - "Sometimes the Simplest Things Can Have the Greatest Impact" 139 New Application of Artificial Intelligence for Mechanical Ventilation 184 Brazil - "Elmo" Helmet Saves Lives at the Peak of COVID 328 Helmet-Based Ventilation Webinar with Experts 144 Monitoring Device for Helmet CPAP - FDA EUA Approved 162 Helmet NIV Success: Combining Knowledge and Experience 142 Bioengineers Developed Open-Source NIV Helmet Design 281 Hands-On Review - Harol Hoods from Italy 245 Webinar - NIV Respiratory Assist Helmets Evaluated by Emergency Care Research Institute (ECRI) 200 OxyJet CPAP - Simple Design and Low-Cost System for Non-Invasive Ventilation 701 Oxygen Hoods Reduced the Need for Intubation in COVID-19 Patients 377 Hands-On Review - Haven Hoods from Phoenix Medical Systems, India 675 StarMed - Decades of Experience in Creating Optimal Helmet Design for Non-Invasive Ventilation 399 Hands-On Review - NIV StarMed CaStar R Hood from Intersurgical Ltd 779 New Hampshire Company Focuses on Helmet Accessories to Further Success of NIV Treatment 408 Oxygen Tent Designed From the Heart by Laser Company 350 "Subsalve" Oxygen Treatment Hood Gains FDA Emergency Use Authorization 1,289 Hands-On Review - VYATIL Oxygen Tent from The LMD Power of Light 497 Respiratory Therapist Offers Tips on how to Adopt and Implement Helmet NIV 316 "The Technology to Save Lives, and That’s What We’re All About" Sea-Long Helmet Success Story 497 Infographic | Comparison of Helmet NIV, Face Mask and Invasive Mechanical Ventilation 1,429 A Portable, Low-Cost CPAP/BiPAP and NIV Helmet setup developed by Dr. Khan for COVID-19 patients 1,244

  • Subsalve | Helmet NIV

    Helmets from Subsalve to Ukraine More Details are Comming Soon The helmets were donated ​ You can get our online training course for free! ​ ​ video video

  • Ukraine | Helmet NIV

    Helmets from Texas to Ukraine via Chicago Chicago 3/25/2022 The helmets were donated by Mr. Chris Austin Jr. the owner of Sea-Long Medical Systems . ​ You can get our online training course for free! ​ Here are two videos with the details, in English and in Russian. ​ Russian language video English language video If you know how to use Helmet based ventilation: Each box includes: 10 or 11 Helmet kits: 1 Bacterial/viral filter - can be used as a muffler on the inspiratory port or prevent infection to spread into the environment. 1 Adapter to connect the filter and PEEP valve 1 PEEP valve 5 Hood clips 2 Underarm straps 1 Manual from the Manufacturer 1 Measuring tape to measure neck circumference ​ Video (11 min) How to assemble helmet - video from Manufacturer: 0:36 - measure patient's neck 1:24 - cut the neck seal 2:40 - apply the helmet 6:14 - unpacking the kit 7:25 - assemble the helmet 8:59 - apply clips and underarm straps Video (6.5 min) Set up by Dr. Cereda - connected helmet to max Ventury to deliver CPAP therapy. ​ If you want to learn how to use helmet based ventilation: Free online course (in English): Module 1: Introduction to NIV Module 2: Helmet NIV Indications, Set-up, and Applications Module 3: Monitoring, Titration, and End of Treatment Module 4: Helmet NIV Issues and Solutions Module 5: Helmet NIV Champions Module 6: Helmets and Other Accessories Modules 2,3, and 4 are the most important and practical for first-time helmet users. Supplemental material: Remember that Helmet CPAP is the easiest and most beneficial therapy for most patients. Helmet NIV or bi-level ventilation will require specific settings on the vent. Here is the cheat sheet to use when setting up a ventilator: NOTE: With BiPAP, there are two pressure levels that need to be set. The expiratory positive airway pressure (EPAP), and the inspiratory positive airway pressure (IPAP). Set pressures at 50% higher levels than used with the Face Mask. On BIPAP set the rise time or the speed on the lowest setting as possible and there will be no issues with the triggering. Nursing Checklist for Helmet based ventilation: Mobile Smart Procedure Based on The University of Pennsylvania Medicine Guidelines, Dr. Maurizio F. Cereda (05/25/2020) - Can be downloaded and used offline. Free access: On Web Browser on desktop: On Smartphone and tablet: Download 'AmbiFi' from Apple App Store or Google Play Store Login with credentials: Username: covid19 / Password: Covid19!

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