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Work of breathing using different interfaces in spontaneous positive pressure ventilation: helmet, face-mask, and endotracheal tube

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Abstract

Purpose

Noninvasive positive pressure ventilation (NPPV) using a helmet is expected to cause inspiratory trigger delay due to the large collapsible and compliant chamber. We compared the work of breathing (WOB) of NPPV using a helmet or a full face-mask with that of invasive ventilation by tracheal intubation.

Methods

We used a lung model capable of simulating spontaneous breathing (LUNGOO; Air Water Inc., Japan). LUNGOO was set at compliance (C) = 50 mL/cmH2O and resistance (R) = 5 cmH2O/L/s for normal lung simulation, C = 20 mL/cmH2O and R = 5 cmH2O/L/s for restrictive lung, and C = 50 mL/cmH2O and R = 20 cmH2O/L/s for obstructive lung. Muscle pressure was fixed at 25 cmH2O and respiratory rate at 20 bpm. Pressure support ventilation and continuous positive airway pressure were performed with each interface placed on a dummy head made of reinforced plastic that was connected to LUNGOO. We tested the inspiratory WOB difference between the interfaces with various combinations of ventilator settings (positive end-expiratory pressure 5 cmH2O; pressure support 0, 5, and 10 cmH2O).

Results

In the normal lung and restrictive lung models, WOB decreased more with the face-mask than the helmet, especially when accompanied by the level of pressure support. In the obstructive lung model, WOB with the helmet decreased compared with the other two interfaces. In the mixed lung model, there were no significant differences in WOB between the three interfaces.

Conclusion

NPPV using a helmet is more effective than the other interfaces for WOB in obstructive lung disease.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Yamagata University Faculty of Medicine, 2-2-2 Iida Nishi, Yamagata, Yamagata, 990-9585, Japan

    Shinya Oda, Kei Otaki, Nozomi Yashima, Misato Kurota, Sachiko Matsushita, Airi Kumasaka, Hutaba Kurihara & Kaneyuki Kawamae

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  1. Shinya Oda
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  2. Kei Otaki
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  3. Nozomi Yashima
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Correspondence to Shinya Oda.

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Oda, S., Otaki, K., Yashima, N. et al. Work of breathing using different interfaces in spontaneous positive pressure ventilation: helmet, face-mask, and endotracheal tube. J Anesth 30, 653–662 (2016). https://doi.org/10.1007/s00540-016-2168-3

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  • DOI: https://doi.org/10.1007/s00540-016-2168-3

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