From Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy (C.O., G.C., R.V., A.M., P.B., F.D.C.); Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy (F.L., P.N.); the Medical Statistics and Cancer Epidemiology Unit, Eastern Piedmont University "A. Avogadro," Novara, Italy (T.C., C.M.); the Department of Translational Medicine, Eastern Piedmont University "A. Avogadro," Novara, Italy (F.D.C., P.N.); and CRRF Mons. L. Novarese, Moncrivello (VC), Italy (P.N.).
Anesthesiology. 2016 Jan;124(1):101-8. doi: 10.1097/ALN.0000000000000910.
The helmet is a well-tolerated interface for noninvasive ventilation, although it is associated with poor patient-ventilator interaction. A new helmet (NH) has proven to attenuate this limitation of the standard helmet (SH) in both bench study and healthy volunteers. The authors compared a NH and a SH in intensive care unit patients receiving noninvasive ventilation for prevention of postextubation respiratory failure; both helmets were also compared with the endotracheal tube in place before extubation.
Fourteen patients underwent 30-min trials in pressure support during invasive ventilation and then with a SH and a NH in a random order. The authors measured comfort, triggering delays, rates of pressurization (airway pressure-time product [PTP] of the first 300 [PTP(300-index)] and 500 [PTP(500-index)] ms from the onset of effort, and the first 200 ms from the onset of insufflation [PTP200]), time of synchrony between effort and assistance (Time(synch)/Ti(neu)), respiratory drive and frequency, arterial blood gases (ABGs), and rate of asynchrony.
Compared with SH, NH improved comfort (5.5 [5.0 to 6.0] vs. 8.0 [7.8 to 8.0]), respectively, P < 0.001), inspiratory trigger delay (0.31 [0.22 to 0.43] vs. 0.25 [0.18 to 0.31] s, P = 0.007), and pressurization (PTP(300-index): 0.8 [0.1 to 1.8] vs. 2.7 [7.1 to 10.0]%; PTP(500-index): 4.8 [2.5 to 9.9] vs. 27.3 [16.2 to 34.8]%; PTP200: 13.6 [10.1 to 19.6] vs. 30.4 [24.9 to 38.4] cm H2O/s, P < 0.01 for all comparisons) and Time(synch)/Ti(neu) (0.64 [0.48 to 0.72] vs. 0.71 [0.61 to 0.81], P = 0.007). Respiratory drive and frequency, ABGs, and rate of asynchrony were not different between helmets. Endotracheal tube outperformed both helmets with respect to all variables, except for respiratory rate, ABGs, and asynchronies.
Compared with a SH, a NH improved comfort and patient-ventilator interaction.
头盔是一种能耐受的无创通气接口，但它与较差的人机同步性相关。一种新型头盔（NH）已被证明能减轻标准头盔（SH）在床旁实验和健康志愿者中的这一限制。作者比较了 NH 和 SH 在因预防拔管后呼吸衰竭而接受无创通气的重症监护病房患者中的应用；同时，这两种头盔也与拔管前的气管内导管进行了比较。
14 名患者在有创通气时接受 30 分钟压力支持试验，然后以随机顺序分别使用 SH 和 NH。作者测量了舒适度、触发延迟、加压率（从用力开始的前 300ms 的气道压力时间乘积[PTP（300-index）]和前 500ms 的 PTP（500-index），以及从充气开始的前 200ms 的 PTP200）、用力与辅助之间的同步时间（Time（sync）/Ti（neu））、呼吸驱动和频率、动脉血气（ABG）和失同步率。
与 SH 相比，NH 改善了舒适度（5.5 [5.0 到 6.0] 对 8.0 [7.8 到 8.0]，P<0.001）、吸气触发延迟（0.31 [0.22 到 0.43] 对 0.25 [0.18 到 0.31] s，P=0.007）和加压（PTP（300-index）：0.8 [0.1 到 1.8] 对 2.7 [7.1 到 10.0]%；PTP（500-index）：4.8 [2.5 到 9.9] 对 27.3 [16.2 到 34.8]%；PTP200：13.6 [10.1 到 19.6] 对 30.4 [24.9 到 38.4] cm H2O/s，所有比较的 P<0.01）和 Time（sync）/Ti（neu）（0.64 [0.48 到 0.72] 对 0.71 [0.61 到 0.81]，P=0.007）。头盔之间的呼吸驱动和频率、ABG 和失步率没有差异。气管内导管在除呼吸频率、ABG 和失步率外的所有变量上均优于两种头盔。
与 SH 相比，NH 提高了舒适度和人机同步性。
