Lucchini Alberto, Bambi Stefano, Gurini Silvia, Di Francesco Enrico, Pace Luigino, Rona Roberto, Fumagalli Roberto, Foti Giuseppe, Elli Stefano
Alberto Lucchini, RN, General Intensive Care Unit, Emergency Department, ASST Monza, San Gerardo Hospital, Monza; and University of Milano-Bicocca, Milan, Italy. He is the coordinator of the master's degree program in intensive and critical care nursing at Milano-Bicocca University, Italy. His main publications concern the nursing workload in intensive care, nursing care of ECMO patients, invasive and non-invasive mechanical ventilation, endotracheal suctioning. Stefano Bambi, PhD, MSN, RN, Medical and Surgical Intensive Care Unit, Careggi University Hospital, Florence, Italy. He is a staff nurse and professor in charge at Florence University and Milano-Bicocca University. His main publications concern the, invasive and non-invasive mechanical ventilation, nursing in critical care settings. Silvia Gurini, RN, Emergency Department, ASST Valtellina ed Alto Lario, Italy. Enrico di Francesco, RN, Cardiosurgical Intensive Care Unit, S. Antonio Hospital, Padova, Italy. Luigino Pace, RN, General Intensive Care Unit, APSS-Santa Maria del Carmine Hospital, Rovereto, Italy. Roberto Rona, MD, General Intensive Care Unit, Emergency Department, ASST Monza, San Gerardo Hospital, Monza; and University of Milano-Bicocca, Milan, Italy. Roberto Fumagalli, MD, is a professor in the University of Milan-Bicocca located in Milan, Italy. He is also the director of the Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda Hospital of Milan, Italy. Giuseppe Foti, MD, General Intensive Care Unit, Emergency Department, ASST Monza, San Gerardo Hospital, Monza; and University of Milano-Bicocca, Milan. Stefano Elli, RN, General Intensive Care Unit, Emergency Department, ASST Monza, San Gerardo Hospital, Monza; and University of Milano-Bicocca, Milan.
Dimens Crit Care Nurs. 2020 Jul/Aug;39(4):194-202. doi: 10.1097/DCC.0000000000000430.
The aim of this study was to assess the noisiness levels produced by different gas source systems, breathing circuits setup, and gas flow rates during continuous positive airway pressure (CPAP) delivered through helmet.
This was a crossover design study. Ten healthy subjects received helmet CPAP at 5 cm H2O in random order with different gas flow rates (60 and 80 L/min), 3 diverse gas source systems (A: Venturi system, B: oxygen and air flowmeters, C: electronic Venturi system), and 3 different breathing circuit configurations. During every step of this study, a heat and moisture exchanger (HME) was placed on the helmet inlet gas port to measure the effects on noise production. Noise intensity level was recorded through a sound-level meter. Participants scored their noisiness perception on a visual analog scale.
The noise level inside the helmet ranged between 76 ± 4 and 117 ± 1 Decibel A. The gas source and the gas flow rate always affected the noise level inside and outside the helmet (P < .001). The different "breathing circuit setup" did not change the noise levels inside the helmet (P = .244), but affected the noise level outside, especially when a Venturi system was used (P < .001). An HME filter placed at the junction between the inspiratory limb of the breathing circuit and the helmet significantly decreased the noise intensity inside the helmet (mean dBA without HME, 99.56 ± 13.30 vs 92.26 ± 10.72 with HME; P < .001) and outside (mean dBA without HME, 68.16 ± 12.05 vs 64.97 ± 12.17 with HME; P < .001). The perception of noise inside the helmet was lower when an HME filter was placed on the inspiratory inlet gas port (median, 6 [interquartile range, 4-7] vs 7 [5-8]; P < .001).
When helmet CPAP is delivered through gas flow rates up to 50 L/min, an HME placed on the helmet inlet gas port should be used to reduce noise inside the helmet and to improve patients' comfort.
本研究旨在评估通过头盔进行持续气道正压通气（CPAP）时，不同气体源系统、呼吸回路设置和气体流速所产生的噪音水平。
这是一项交叉设计研究。10名健康受试者以随机顺序接受5 cm H₂O的头盔CPAP，采用不同的气体流速（60和80 L/min）、3种不同的气体源系统（A：文丘里系统，B：氧气和空气流量计，C：电子文丘里系统）以及3种不同的呼吸回路配置。在本研究的每个步骤中，在头盔进气口放置一个热湿交换器（HME），以测量其对噪音产生的影响。通过声级计记录噪音强度水平。参与者在视觉模拟量表上对他们的噪音感知进行评分。
头盔内的噪音水平在76±4至117±1分贝A之间。气体源和气体流速始终会影响头盔内外的噪音水平（P<.001）。不同的“呼吸回路设置”并未改变头盔内的噪音水平（P = 0.244），但会影响头盔外的噪音水平，尤其是在使用文丘里系统时（P<.001）。放置在呼吸回路吸气支与头盔连接处的HME过滤器显著降低了头盔内的噪音强度（无HME时平均分贝A为99.56±13.30，有HME时为92.26±10.72；P<.001）以及头盔外的噪音强度（无HME时平均分贝A为68.16±1,2.05，有HME时为64.97±12.17；P<.001）。当在吸气进气口放置HME过滤器时，头盔内的噪音感知较低（中位数，6[四分位间距，4 - 7]对7[5 - 8]；P<.001）。
当通过高达50 L/min的气体流速进行头盔CPAP时，应在头盔进气口放置HME以降低头盔内的噪音并提高患者舒适度。
