Noninvasive Continuous Positive Airway Pressure in Acute Respiratory Failure: Helmet Versus Facial Mask

OBJECTIVE: Noninvasive continuous positive airway pressure (nCPAP) is applied through different interfaces to treat mild acute respiratory failure (ARF) in infants. Recently a new pediatric helmet was introduced in clinical practice to deliver nCPAP. The objective of this study was to compare the feasibility of the delivery of nCPAP by the pediatric helmet with delivery by a conventional facial mask in infants with ARF. PATIENTS AND METHODS: We conducted a single-center physiologic, randomized, controlled study with a crossover design on 20 consecutive infants with ARF. All patients received nCPAP by helmet and facial mask in random order for 90 minutes. In infants in both trials, nCPAP treatment was preceded by periods of unassisted spontaneous breathing through a Venturimask. The primary end point was the feasibility of nCPAP administered with the 2 interfaces (helmet and facial mask). Feasibility was evaluated by the number of trial failures defined as the occurrence of 1 of the following: intolerance to the interface; persistent air leak; gas-exchange derangement; or major adverse events. nCPAP application time, number of patients who required sedation, and the type of complications with each interface were also recorded. The secondary end point was gas-exchange improvement. RESULTS: Feasibility of nCPAP delivery was enhanced by the helmet compared with the mask, as indicated by a lower number of trial failures (P .001), less patient intolerance (P .001), longer application time (P .001), and reduced need for patient sedation (P .001). For both delivery methods, no major patient complications occurred. CONCLUSIONS: The results of this current study revealed that the helmet is a feasible alternative to the facial mask for delivery of nCPAP to infants with mild ARF. Pediatrics 2010;126:e330–e336 AUTHORS: Giovanna Chidini, MD,a Edoardo Calderini, MD,a Bruno Mario Cesana, MD,b Cristiano Gandini, MD,a Edi Prandi, MD,a and Paolo Pelosi, MDc aPediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; bMedical Statistics and Biometry, University of Brescia, Brescia, Italy; and cDepartment of Environmental Medicine, Health and Safety, University of Insubria, Varese, Italy