Bongiovanni Filippo, Michi Teresa, Natalini Daniele, Grieco Domenico L, Antonelli Massimo
Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
Expert Rev Respir Med. 2023 Jan;17(1):27-39. doi: 10.1080/17476348.2023.2174974. Epub 2023 Feb 9.
Non-invasive ventilation (NIV) represents an effective strategy for managing acute respiratory failure. Facemask NIV is strongly recommended in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypercapnia and acute cardiogenic pulmonary edema (ACPE). Its role in managing acute hypoxemic respiratory failure (AHRF) remains a debated issue. NIV and continuous positive airway pressure (CPAP) delivered through the helmet are recently receiving growing interest for AHRF management.
In this narrative review, we discuss the clinical applications of helmet support compared to the other available noninvasive strategies in the different phenotypes of acute respiratory failure.
Helmets enable the use of high positive end-expiratory pressure, which may protect from self-inflicted lung injury: in AHRF, the possible superiority of helmet support over other noninvasive strategies in terms of clinical outcome has been hypothesized in a network metanalysis and a randomized trial, but has not been confirmed by other investigations and warrants confirmation. In AECOPD patients, helmet efficacy may be inferior to that of face masks, and its use prompts caution due to the risk of CO rebreathing. Helmet support can be safely applied in hypoxemic patients with ACPE, with no advantages over facemasks.
无创通气（NIV）是治疗急性呼吸衰竭的一种有效策略。对于伴有高碳酸血症的慢性阻塞性肺疾病急性加重期（AECOPD）和急性心源性肺水肿（ACPE）患者，强烈推荐使用面罩无创通气。其在治疗急性低氧性呼吸衰竭（AHRF）中的作用仍存在争议。最近，通过头盔进行的无创通气和持续气道正压通气（CPAP）在AHRF治疗中越来越受到关注。
在本叙述性综述中，我们讨论了与其他可用的无创策略相比，头盔支持在不同表型急性呼吸衰竭中的临床应用。
头盔能够使用较高的呼气末正压，这可能预防肺自身损伤：在AHRF中，网络荟萃分析和一项随机试验推测头盔支持在临床结局方面可能优于其他无创策略，但尚未得到其他研究的证实，仍需进一步确认。在AECOPD患者中，头盔的疗效可能不如面罩，且由于存在二氧化碳重复吸入的风险，使用时需谨慎。头盔支持可安全应用于ACPE低氧血症患者，但与面罩相比并无优势。
