General Intensive Care Unit, Emergency Department, ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Monza, MB, Italy.
Emergency, ECMO and Trauma Intensive Care Unit, Azienda Ospedaliero Careggi University Hospital, Florence, Italy.
Nurs Crit Care. 2019 Nov;24(6):369-374. doi: 10.1111/nicc.12399. Epub 2018 Nov 20.
Prolonged application time of helmet continuous positive airway pressure (CPAP) leads to better outcomes, but its timing can be influenced by the patient's tolerance.
To investigate patients' pain and tolerance experience related to different options of helmet fixing system: 'armpits strap' versus 'counterweights system'.
This was a non-randomized crossover study performed in a 10-bed intensive care unit and referral extra corporeal membrane oxigenation (ECMO) centre of an Italian university hospital.
Twenty patients were enrolled. For helmet-CPAP cycles performed with the armpit straps option, the mean pain numerical rate on a 0-10 scale was: 0·5 ± 1·4 at T (baseline) 1·5 ± 2·0 at T (after 1 h) and 2·6 ± 2·5 at T (end of cycle) (p = 0·023). The same analysis was performed for the counterweights fixing option. The mean score was 0·3 ± 0·6 at T , 0·3 ± 0·2 at T and 0·5 ± 0·7 at T (p = 0·069). The mean duration for CPAP cycles performed with armpits strap and counterweights system was 3·0 ± 1·0 and 3·9 ± 2·3 h, respectively (p < 0·001). The mean section of the Basilic vein that was investigated before wearing the helmet was equal to 0·23 ± 0·20 cm . After 1 h of therapy with the counterweight option and armpit straps, the mean increase of the vein's section was 0·27 ± 0·21(p = 0·099) and 0·30 ± 0·25, respectively (p = 0·080).
The fixing system options in use to anchor the helmet during CPAP could worsen the pain experience level and cause device-related pressure ulcers. When compared with the armpit straps option, the counterweights system appears to be a suitable approach to minimize the risks of pressure sores and pain during the treatment.
The helmet CPAP is a reliable therapy to manage acute respiratory failure. Major improvements regarding pulmonary alveolar recruitment and oxygen levels are strictly related to a prolonged time of helmet CPAP cycles. Using a counterweight fixing system, where the armpits straps are not necessary, could be helpful in reducing patients' pain experience.
延长头盔持续气道正压通气（CPAP）的应用时间可带来更好的效果，但通气时机可能会受到患者耐受性的影响。
旨在调查不同头盔固定系统（“腋窝带”与“配重系统”）与患者疼痛和耐受体验的关系。
这是在意大利一所大学医院的 10 张病床重症监护病房和转介体外膜肺氧合（ECMO）中心进行的非随机交叉研究。
共纳入 20 例患者。在使用腋窝带固定头盔 CPAP 循环时，0-10 数字疼痛评分在 T（基线）时为 0.5±1.4，在 T（1 小时后）时为 1.5±2.0，在 T（循环结束时）时为 2.6±2.5（p=0.023）。对配重固定选项进行了相同的分析。平均评分为 T 时 0.3±0.6，T 时 0.3±0.2，T 时 0.5±0.7（p=0.069）。使用腋窝带和配重系统进行 CPAP 循环的平均时间分别为 3.0±1.0 和 3.9±2.3 小时（p<0.001）。在佩戴头盔之前，对贵要静脉的平均截面进行了检查，结果为 0.23±0.20 cm。在使用配重选项和腋窝带治疗 1 小时后，静脉截面的平均增加量分别为 0.27±0.21（p=0.099）和 0.30±0.25（p=0.080）。
用于在 CPAP 期间固定头盔的固定系统选择可能会加重疼痛体验水平并导致与设备相关的压疮。与腋窝带选项相比，配重系统似乎是一种降低治疗过程中压疮和疼痛风险的合适方法。
头盔 CPAP 是治疗急性呼吸衰竭的可靠疗法。肺肺泡募集和氧合水平的显著改善与头盔 CPAP 周期的延长密切相关。使用不需要腋窝带的配重固定系统可能有助于减轻患者的疼痛体验。
