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  • 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 HelmetBasedVentilation.com 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/rs.3.rs-845769/v1 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. https://rebelem.com/recovery-rs-cpap-vs-hfno-vs-conventional-oxygen-therapy-in-covid-19/ 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. https://www.stemlynsblog.org/jc-non-invasive-ventilation-for-covid-19-patients-the-recovery-rs-trial-st-emlyns/

  • DIMAR Helmets Support Varied Use for COVID and Non-COVID Patients

    11/02/2021 Chicago Helmets for non-invasive ventilation may be new to the United States, but in Italy, manufacturers like DIMAR have been making them for decades. The COVID-19 global pandemic means DIMAR’s helmet production is even more important to the countries and hospitals using these life-saving devices. Company owner Maurizio Borsari has 35 years of experience in the respiratory critical care field. He founded DIMAR in 2002 to produce and market biomedical devices for the treatment of Acute Respiratory Failure, or ARF, and non-invasive ventilation, or NIV, technologies. According to its website, DIMAR supplies about 750 departments in 250 Italian hospitals and 50 national distributors, which serve hundreds of hospitals in Europe and not only. The company has increased production size seven times and will double its laboratory space this fall. Yet, during a tour of the facility, company export manager Riccardo Lambertini noted it’s still a small enough company that many workers do multiple jobs, from research and development to testing and production. Two kinds of helmets DIMAR manufactures two types of helmets: CPAP, which stands for continuous positive airway pressure, and NIV, or non-invasive ventilation (Pressure Support Ventilation and bilevel ventilation). The CPAP helmet has no interaction between patient and machine, Lambertini explained. The airflow runs inside the helmet regardless of what the patient is doing. It’s continuous, and “the patient just takes what he needs from inside the helmet; pressure inside the interface remains stable and diaphragm works physiologically,” he said. The NIV helmet is connected to a ventilator, and as the patient inhales, the ventilator pushes air into the lungs. “If you move to NIV, it is obvious there’s a kind of communication/interaction between the patient and the ventilator,” Lambertini said. The CPAP helmet DIMAR produces is made from flexible biomedical plastic film and has a zipper across the lower front area. It includes a number of connectors to attach oxygenated airflow, a PEEP valve, filters, a manometer, or other devices to measure temperature, pressure, or flow inside the helmet. The neck collar is stretchy and unbreakable but provides a tight seal during use. DIMAR’s NIV helmet is made from stiffer biomedical plastic film with a thicker and more rigid neck collar. It is designed to be less compliant and limit the balloon effect, which you don’t want with a ventilator, Lambertini said. The rigid ring stabilizes the structure and connectors so they don’t move up and down during breathing, which could cause patient-ventilator asynchrony. But where DIMAR has created two helmets – one for each kind of use, CPAP or NIV – the US only has one helmet design approved for use with COVID patients. Lambertini said three things make a helmet a good interface: Patient comfort and easy management for long term treatment Absence of air leaks Dilution of carbon dioxide, or CO2 Comfortable and easy to use Helmets are more comfortable than full-face masks. They have a universal fit so the patient's facial shape is not an issue during helmet-based ventilation because nothing is touching their face. On the other hand, the mask puts lots of pressure on the face and head, which makes long-term use very difficult to maintain. Mr. Borsari demonstrated different pressure points using a water bottle. The same weight distributed in different ways will create more or less pressure. But even a light touch of your finger on your hand after an hour can result in a bruise. DIMAR’s helmets have straps that go under the patient’s arms to help create a good seal around the neck and keep the helmet from rising up or bobbing up and down during breathing. The helmets also have plastic loops at the top to add straps connected to weight to push the helmet down from the top in addition to the underarm straps. It releases pressure from under the arms for long-term helmet users, Lambertini said, offering greater patient comfort. The zipper can be opened by the patient or clinician to allow easy access to eat or put on glasses to read, for example. Even if the helmet needs to stay in place, the connectors allow for a straw to be inserted to get a sip of water, perform oral care or suction. DIMAR also offers a nebulizer attachment that fits the helmet interface. The clear plastic helmet allows the patient to see out all sides, zip opening doesn’t limit the 360° surrounding view. Adding filters to the airflow inlet and outlet protects from pathogenic agent aerosolization and greatly reduces noise in the helmet so patients can hear and speak easily. Patients also can talk while using the helmet, something that’s not possible with a face mask interface. In less than five minutes, Lambertini and a colleague placed a CPAP helmet on Aurika Savickaite to demonstrate how easy it is to use. They checked the helmet, put it on her, and connected it to a venturi system. After a few minutes, Lambertini and Savickaite switched it to wall air and then added oxygen, showing the flexibility of its uses. Removing the helmet also requires two people to stretch the neck collar to the sides and gently take off the patient’s head. But once it’s in place, only one person is needed to adjust the airflow, oxygen, pressures and attach any other accessories. Absence of air leaks Face masks don’t fit perfectly on some people’s faces, which means there are air leaks that can affect the delivery of oxygen and pressure to the patient’s lungs. DIMAR’s helmets are designed to have no air leaks. They are tested by inflating them under 100 centimeters of water pressure to make sure there are no leaks in the interface. This is why the helmet will inflate instantly when connected to the airflow or the ventilator. In a COVID environment, the CPAP helmet isn’t a protective device, Lambertini said, but it is less polluted. Placing a “filter before the PEEP valve can protect the environment from pathogenic agent actualization, which is something really problematic with a high-flow nasal cannula or with a face mask,” he said. Washing out CO2 Patients exhale carbon dioxide, which can cause problems if it’s rebreathed or allowed to build up. “When the helmet was invented, we thought – they thought – the CO2 was higher around the neck or around the head of the patient,” Lambertini said. “So having the connection in this position,” he said as he pointed to his face, “helped the washout. But now we know the CO2 is in this area (bottom) of the helmet, so having the connectors here is better,” he said pointing to his shoulders. DIMAR’s CPAP helmet has more than two connections to separate inspiration and expiration. “It is much easier for the gas flow to enter and leave the interface, and this setup can generate a better washout,” Lambertini said. The additional connector ports are also used to create intentional air leakage to increase the CO2 washout. The volume of a helmet is greater than a face mask, so the patient will inhale more CO2 from a mask than a helmet, in case the airflow is lost, Lambertini said. Because, each minute, 100 to 300 milliliters of CO2 can be diluted faster in a six-liter helmet. There’s no contraindication for using filters, Lambertini added. Just keep in mind that a filter will add 3-4 centimeters of pressure, which will affect the PEEP, or positive end-expiratory pressure, in the helmet CPAP. “If you put the filter in the line with the PEEP valve, the value you set is lower than actual pressure in the helmet. Trust the manometer, not the indication on the PEEP valve” when using a helmet for CPAP setup, he said. Understanding how it works There’s a hesitancy among some clinicians and patients to use helmets. Lambertini said people have been told not to put a plastic bag over their heads, so they are worried about being able to breathe in a plastic helmet. Even some nurses say they would rather use a face mask than a helmet with their patients, he added. Despite the fact that they have never tested it personally, they make assumptions without looking into the physics, design features, testings, and studies that have been conducted on the safety and positive outcomes of using helmets for non-invasive ventilation. “It’s really a matter of being able to explain how it works and why it’s safe. That’s the key point. If you have some doubts, sometimes it’s difficult to make the patient comfortable,” Lambertini said. “This is what we mean when we say that you need to be confident with the machines you are using, with the devices and the interfaces, because when you understand how it works, you can do whatever you want and switch from one device to the other very easily, being confident with what you are doing.” Video:

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  • Helmet-based Ventilation-Online Course

    Helmet-Based Ventilation for Acute Respiratory Failure A Step-by-Step Course on Helmet Based Non-Invasive Positive Pressure Ventilation for COVID and non-COVID patients Reduces the learning curve for healthcare professionals Reduces work for clinicians Reduces rates of intubation, in-hospital mortality, and ICU length of stay Improves patient experience and their tolerance of the treatment Improves non-invasive ventilation success rates Ensures better results sooner with improved patient outcomes Saves money and resources Enroll now A More Effective Solution for COVID-19 Treatment Helmet-based positive pressure ventilation saves lives, shortens ICU stay for patients who need ventilatory support and can be used in step-down units. It is beneficial for all respiratory distress patients, regardless of its cause. Enroll now Our Primary Goal is to supply vital information to clinicians about helmet use for non-invasive ventilation in patients with respiratory distress as a complication of the COVID-19 virus. Benefits offered by this Course ​For healthcare professionals ​ Reduces the learning curve for healthcare professionals implementing helmet-based ventilation treatment for faster adaptation of this life-saving therapy. Accessible to professionals from different departments: RNs, RTs and MDs. Reduces work load for clinicians while increasing non-invasive ventilation (NIV) success rates. Unique course material, not offered by any other learning provider. Includes updates and new development in helmet-based ventilation. ​For patients ​ Lowers rates of intubation, in-hospital mortality, and ICU length of stay Provides painless respiratory support, thereby improves patient experience and tolerance of the NIV therapy Ensures timely application and perfect fit, increasing the chances of positive patient outcomes. 1. Kyeremanteng, K., Gagnon, L. P., Robidoux, R., Thavorn, K., Chaudhuri, D., Kobewka, D., & Kress, J. P. (2018). Cost Analysis of Noninvasive Helmet Ventilation Compared with Use of Noninvasive Face Mask in ARDS. Canadian respiratory journal, 2018, 6518572. https://doi.org/10.1155/2018/6518572 2. Norris, C., Jacobs, P., Rapoport, J., & Hamilton, S. (1995). ICU and non-ICU cost per day. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 42(3), 192–196. https://doi.org/10.1007/BF03010674 3. Patel, B. K., Wolfe, K. S., Pohlman, A. S., Hall, J. B., & Kress, J. P. (2016). Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA, 315(22), 2435–2441. https://doi.org/10.1001/jama.2016.6338 WHAT EXPERTS ARE SAYING The course is impressive, thorough, detailed, and a must-see for all inter-professional teams working with COVID-19 patients (at a minimum). I was engaged immediately in Module 1 by the history of helmet-based ventilation. I found it fascinating and informative (and plan to share it with others). Module 2 was well placed and instructive (especially to a neophyte like me) about basic pathophysiology, physiological explanations, and their interface with different helmet applications (i.e., CPAP & PAV). The clinical descriptions were informative & detailed. Module 3 was beneficial because it addressed many of the incidental questions providers might have in a classroom. These explanations were also detailed and thorough. The details would have been extremely useful to me if I worked with these helmets! My favorite section of this module was the self-proning & weaning section. I found myself saying, “wow, I never knew!” a couple of times. I also love that you have included the helmet failure factors. That is a necessary component of any education. In Module 4 , the issues and solutions sections were also comprehensive and thought-provoking. I especially loved the nursing interventions and nursing checklist. Module 5 is very timely to the future of nursing 2030 report in that it detailed the importance and pathways for creating inter-professional helmet teams. Detailing patient education and costs s separate considerations again demonstrates the thoroughness of the education, especially from a nurse’s and administrator’s viewpoint. In Module 6 , I found the design discussions between helmets fascinating and instructive. I particularly like that it emphasizes the discussion is focused on the United States' availability of helmets. The accessories discussion offered a thorough approach to what otherwise might be overlooked in a presentation of equipment. One of the essential takeaways I discovered is that helmets and helmet-based ventilation are patient-friendly, provider-friendly, and resource-friendly. Park Balevre, DNP, RN-BC, CNE Associate Professor, Doctor of Nursing Practice DNP Program at Chamberlain University College of Nursing Course Modules Module 1: Introduction to NIV Lesson 1: History, Trends and Challenges of NIV ​ Lesson 2: Current Helmet NIV Use ​ Lesson 3: The Benefits of Helmet NIV ​ Module 1: Suggested Reading ​ Module 1: Quiz ​ ​ ​ ​ ​ ​ Module 2: Helmet NIV Indications, Set-up, and Applications Lesson 1: Oxygen Delivery Configurations and Settings ​ Lesson 2: Helmet Preparation, Application and Removal ​ Lesson 3: Indications for Helmet NIV ​ Module 2: Quiz ​ ​ ​ Module 3: Monitoring, Titration, and End of Treatment Lesson 1: Starting Therapy ​ Lesson 2: Titration of PEEP, Fi02 and Flow Rate ​ Lesson 3: Benefits of Self-proning ​ Lesson 4: Helmet NIV Weaning ​ Lesson 5: Helmet NIV Failure and Intubation ​ Module 3: Quiz Enroll now Module 4: Helmet NIV Issues and Their Solutions Lesson 1: Carbon Dioxide Rebreathing ​ Lesson 2: Air Leaks ​ Lesson 3: Asynchrony with the Ventilator ​ Lesson 4: Anxiety and Claustrophobia ​ Lesson 5: Noise and Pressure in Ears ​ Lesson 6: Skin Irritation and Injuries ​ Lesson 7: Meeting Patient's Basic Needs and Providing Comfort ​ Module 4: Nursing Checklist ​ Module 4: Quiz Module 5: Helmet NIV Champions Lesson 1: Essential Elements for Success ​ Lesson 2: Patient Education ​ Lesson 3: Cost of Helmet NIV ​ Module 5: Quiz ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Module 6: Helmets and Other Accessories Lesson 1: Helmets Available in the US ​ Lesson 2: Key Elements of Helmet Design ​ Lesson 3: Helmet Accessories ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Enroll now About Your Instructor Aurika Savickaite, RN, MSN, was involved in successfully testing the helmet interface in the ICU at the University of Chicago during a three-year trial study. She was awarded a Master of Science in Nursing as an Acute Care Nurse Practitioner at Rush University College of Nursing in 2014. There, she did her case presentation, Non-invasive Positive Pressure Ventilation (NIPPV) for Treatment of Acute Respiratory Failure in Immunocompromised Patient, based on her experience with ventilation via the helmet. ​ Savickaite has worked as a registered nurse and patient care manager at the University of Chicago Medical Center, Medical Intensive Care Unit, and as a staff nurse at Vilnius University Hospital, Santariskiu Clinic, in the intensive care unit. ​ Aurika Savickaite has been committed to community service for many years. Currently, she is a member of the Chicagoland Lithuanians Rotary Club and creator of the HelmetBasedVentilation.com She also provides trainings to clinicians on site or virtually. Dr. John Kress, Advisor John P. Kress, MD , specializes in all areas of pulmonary and critical care medicine. He has a particular interest in respiratory failure and shock. He also serves as director of the Pulmonary and Critical Care Procedure Service, specializing in a variety of invasive medical procedures. Dr. Kress sees patients in the outpatient pulmonary medicine clinic. Dr. Kress' research has focused on sedation for critically ill patients with respiratory failure, and early intervention in patients with respiratory failure to reduce functional decline after discharge from the ICU. Enroll now Enroll Now for Instant Access Instantly, begin your learning experience. You will have full access to course modules, downloadable files, updates all the latest information about helmet-based ventilation and these other features that your course has... Sale $189.00 Special Price $125 for countries not in the World Bank "high-income group" . Helmet-Based Ventilation for Acute Respiratory Failure ​ HD Quality Video Lessons Free Lifetime Updates 30 Day Money-back Guarantee Enroll Now Need to purchase the course for multiple users? Email support@HelmetBasedVentilation.com for discounted rates. 30 Day Money Back Guarantee Enroll Today and get reassurance that if the course doesn't work for you, you have 30 days to request your money back with no questions asked. Although all our students have loved the course so far, we want to make sure you get your value for money and find our product helpful. Frequently Asked Questions When should I start seeing results? Upon buying or completing the course? If all team members have completed the course (RN, RT, and MD) and have applied at least 10-15 helmets in practice. What type of results do you see from other students who have taken this course? We observed clinicians who received educational training on the device start using it in practice much faster and have more confidence when operating it for the first time. We also saw positive results in patients who received helmet-based ventilation and avoided mechanical intubation compared to patients who were using face masks. How much money should I expect to save a year after completing this course? The savings are significant. Although it’s hard to quantify on an individual basis, a study by Kyeremanteng et al. (2018) showed that a helmet interface could save 449 million dollars a year in the US if used instead of a full face mask for selected group of patients. Do you offer any type of discount? Yes, we do. If you belong to an organization or have multiple healthcare professionals who want to take the course, please email us at support@HelmetBasedVentilation.com. Special Price $125 for countries not in the World Bank "high-income group". How long would it take me to finish this course? A total of four hours. Why should I buy this course from you? Course creators researched it and consulted with experts in the field. In addition, the course was reviewed by clinicians, long-time helmet users and bioengineers. "The materials are based on their unique first-hand knowledge of the equipment on the market, and are designed to provide the most critical information which respects the learner’s background and limited time. This course is a must for people planning to implement HNIV in their facility, and is highly recommended for current practitioners in order to get up-to-date with current literature and methods. John Selker Lead Investigator for the Oregon State Univeristy Fast Response Respiration team (OFRR)" An Investment for both Staff and Patients This unique course provides invaluable information about the value and implementation of helmet-based ventilation. The benefits for investing in this course will pay dividends in the quality of care your staff can provide, the improved treatment of affected patients, and the value of your clinic to the community it serves. Enroll today. Enroll Now Legal Disclaimer Conflict of Interest Disclosure TOS Privacy Policy

  • 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 Is CPAP Therapy the Best for COVID Patients: What do We Know? 109 DIMAR Helmets Support Varied Use for COVID and Non-COVID Patients 305 Helmet Manufacturer Harol - NIV Experts for over 40 Years 57 Solutions to Medical Challenges - "Sometimes the Simplest Things Can Have the Greatest Impact" 123 New Application of Artificial Intelligence for Mechanical Ventilation 121 Brazil - "Elmo" Helmet Saves Lives at the Peak of COVID 300 Helmet-Based Ventilation Webinar with Experts 133 Monitoring Device for Helmet CPAP - FDA EUA Approved 152 Helmet NIV Success: Combining Knowledge and Experience 132 Bioengineers Developed Open-Source NIV Helmet Design 250 Hands-On Review - Harol Hoods from Italy 231 Webinar - NIV Respiratory Assist Helmets Evaluated by Emergency Care Research Institute (ECRI) 196 OxyJet CPAP - Simple Design and Low-Cost System for Non-Invasive Ventilation 660 Oxygen Hoods Reduced the Need for Intubation in COVID-19 Patients 362 Hands-On Review - Haven Hoods from Phoenix Medical Systems, India 661 StarMed - Decades of Experience in Creating Optimal Helmet Design for Non-Invasive Ventilation 365 Hands-On Review - NIV StarMed CaStar R Hood from Intersurgical Ltd 766 New Hampshire Company Focuses on Helmet Accessories to Further Success of NIV Treatment 392 Oxygen Tent Designed From the Heart by Laser Company 338 "Subsalve" Oxygen Treatment Hood Gains FDA Emergency Use Authorization 1,270 Hands-On Review - VYATIL Oxygen Tent from The LMD Power of Light 484 Respiratory Therapist Offers Tips on how to Adopt and Implement Helmet NIV 310 "The Technology to Save Lives, and That’s What We’re All About" Sea-Long Helmet Success Story 481 Infographic | Comparison of Helmet NIV, Face Mask and Invasive Mechanical Ventilation 1,353 A Portable, Low-Cost CPAP/BiPAP and NIV Helmet setup developed by Dr. Khan for COVID-19 patients 1,229 "Subsalve" Helmet Non-Invasive Ventilation Set-up with safety features 588 Bubble Helmets made in Paraguay bring down the fear in the medical community during COVID-19 555

  • About Us

    About us We've created this website on 3/18/2020 to organize information about the noninvasive ventilation (NIV) via helmet and help health care professionals learn the benefits of this device as it relates to patients with COVID-19, a disease caused by a respiratory virus that can result in severe illness and respiratory distress in some people. ​ We seek to create and provide the global medical community with protocols and tips about helmet use, manufacturers and resources. ​ Using a helmet ventilator can save lives. For countries lacking enough traditional ventilators because of increased hospitalizations from severe cases of COVID-19, noninvasive ventilation (NIV) via helmet offers a viable solution. A three-year trial study at the University of Chicago found ventilation via helmet is superior for these reasons: Results in faster recovery time, shortening an ICU stay Reduces the need to intubate Lowers ICU mortality Results in minimum or no sedation Provides a cost-saving (faster recovery, less invasive treatment and a lower cost device) ​ How YOU CAN HELP: ​ ALERT relevant experts and decision-makers about this info source – SHARE a link to our web www.helmetbasedventilation.com SUGGEST tips & solutions to uplift our own grassroots capacity, i.e. tools to augment and automate with a laser focus on this particular niche, donate to help us hire more technical help SUBMIT INFO & contact/capacity/shortage/resource DATA (non invasive ventilation related ONLY) on worldwide Clinicians, ICU staff and hospital leaders existing manufacturers, their capacities & needs for supplies or funding to expand output potential pivoting manufacturers, their capacities & needs for expertise, supplies or funding to create new capacity public, private and charity funding sources for hospitals and helmet suppliers hospital demand any other relevant ideas and suggestions ​ Aurika Savickaite Aurika Savickaite, RN, MSN, was involved in the successful testing of the helmet ventilator in the ICU at the University of Chicago during a three-year trial study . While in pursuit of a Master of Science in Nursing – Acute Care Nurse Practitioner degree at Rush University College of Nursing (2014), she wrote her capstone paper, Noninvasive Positive Pressure Ventilation (NIPPV) for Treatment of Acute Respiratory Failure in Immunocompromised Patient, based on her experience with ventilation via the helmet. Savickaite has worked as a registered nurse and patient care manager at the University of Chicago Medical Center, Medical Intensive Care Unit, and as a staff nurse at Vilnius University Hospital, Santariskiu Clinic, in the intensive care unit. She earned a Bachelor of Rehabilitation and Nursing at Vilnius University Faculty of Medicine in 2001. ​ Aurika Savickaite has been committed to community service for many years. Currently, she is a member of the Chicagoland Lithuanians Rotary Club. Aurika Savickaite Advisor - Dr. John P. Kress, MD John P. Kress, MD , specializes in all areas of pulmonary and critical care medicine. He has a particular interest in respiratory failure and shock. He also serves as director of the Pulmonary and Critical Care Procedure Service, specializing in a variety of invasive medical procedures. Dr. Kress sees patients in the outpatient pulmonary medicine clinic. Dr. Kress' research has focused on sedation for critically ill patients with respiratory failure, and early intervention in patients with respiratory failure to reduce functional decline after discharge from the ICU. ​ ​ ​ Dr. John P. Kress, MD 2016 video demonstration of how a helmet interface for noninvasive ventilation is assembled and applied to the patient Team David Lukauskas David Lukauskas is an entrepreneur and a biohacker. David has been involved in marketing and advertising for businesses to reach online and in-person customers for nearly 15 years as a business owner and founder. Additionally, he is CEO of Chicago-based Crowd Control DIRECT Inc ., a business he founded in 2009, which supplies waiting line management systems and safety products across the country and abroad. To meet the extreme energy demands of being an entrepreneur, Lukauskas practices biohacking to perform at a high level and maximize human performance. David Lukauskas Viktorija Trimbel Viktorija Trimbel has 26+ years of outstanding track record in corporate and strategic governance, M&A and fundraising advisory for local and international clients as well as the public sector. Also, she is a professional non-executive board director with skills and track-record in corporate governance & strategy, finance, structuring, leading and executing highly complex projects & transactions, design & digitalization of business processes. ​ Her current professional and research interests focus on the convergence of power of the flux networks, platform/network governance, biohacking and artificial intelligence for fast decision making. ​ Viktorija Trimbel has been dedicated to community service and development for many years. She has been mentoring startup companies and entrepreneurs for over 15 years and was listed among Top-100 Women in Tech in Europe 2012. ​ Additionally, she became the first female Governor 2020-2021 of the District 1462 (Lithuania) was invited to join as the Member at the Membership Committee of Rotary International (USA) 2020-2023. Viktorija is also the Founder and Charter President 2018-2020 of the Lituanica International Rotary Club, became the Paul Harris Fellow (PHF) in 2015 and received the National Rotary Award in 2019. Viktorija Trimbel How this project started It all began the evening of March 17, 2020, while Aurika Savickaite and her husband, David Lukauskas, sat around the kitchen table in Chicago. They, like many others throughout the country, weren’t discussing St. Patrick’s Day festivities or the weather – the topic was the COVID-19 virus. ​ Aurika recalled the 3-year trial study and the successful testing of the helmet-based ventilation when she worked at the ICU at the University of Chicago Hospital. ​ Aurika shared this was only a study -- but while helmets were currently being used in Europe to treat COVID-19 affected patients, they were not being used in the United States, where cases of COVID-19 were increasing . ​ The statement caught David by surprise. ​ “What did you just say?” he asked Aurika. ​ That simple question sparked an into-the-night conversation as the couple discussed the potentially deadly outcomes should there not be enough beds in intensive care units or enough ventilators for the patients hospitalized with the COVID-19 virus. ​ The domain HelmetBasedVentilation.com was registered that night. The next day, David was telling his sister, Viktorija Trimbel, about this project. Before David could finish his explanation, Viktorija offered her help and joined the team. ​ Just one day later, the website was launched, it's being updated 24/7, connecting decision-makers and publishing content for medical professionals. Supporters Blue Oceans PR Communications Partner “Blue Oceans PR” is a boutique digital PR agency with a strong focus on reaching top global media and creating a buzz. Being truthful to the original Blue Oceans Strategy, it always looks to find unique brand communication angles while securing relevant publicity for each client. The agency specializes in B2B, Tech, Fintech, SME and complex subject matter public relations, executes national and regional brand communication and offers quality content planning and creation services employing most relevant digital solutions. For more information, visit www.blueoceanspr.com Disclaimer All research and clinical material published on this website is for informational purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Aurika Savickaite will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising therefrom. ​ We share tips and ideas from those using helmets, but these may be off-label and untested ideas and should not be construed as medical advice, FDA approved modifications or proven safe or effective. Please consider these with caution.

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