Continuous positive airway pressure ventilation with helmet in infants under 1 year
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To report the feasibility of helmet use in infants between 1 and 12 months old with acute respiratory failure.
Design and setting
Observations were made before and 2 h after helmet CPAP of 6 cm H2O. Failure was defined as recourse to intratracheal ventilation. Patient stabilization or improvement was defined as a variation <10% or a decrease >10% in one of the following: respiratory rate, inspired oxygen fraction, or capillary partial pressure of CO2. Tolerance was assessed by the pain and discomfort score, the systematic search for pressure sores, and the measurement of helmet humidity and noise level.
Twenty-three infants with a median age of 5 (2–8) months were included. Helmet CPAP failed in two (9%) patients. Stability or improvement occurred in 16 (70%) patients. The pain and discomfort score was stable or improved in 22 (96%). Pressure sores were found in three (13%) infants. Humidity was 98% (98–99%) and fell to 40% (39–43%) after the humidifier was stopped. The noise level in the helmet was 81 (77–94) dB-SPL.
The helmet was a satisfactory interface for CPAP delivery in young infants in more than two-thirds of the cases. Pressure sores can be prevented by placing a cushion in the helmet. Caregivers need to take into account the high humidity and noise levels of this interface.
KeywordsContinuous positive airway pressure Helmet Infant Noninvasive ventilation
We thank the nursing staff of the pediatric intensive care unit of Arnaud de Villeneuve University Hospital for their patience and cooperation, without which the study could not have been performed. We thank C. Stott-Carmeni for translating the manuscript and for editorial assistance. Last, we thank Mr. J. Noguez from the APARD association for his technical assistance.
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