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Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply

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Abstract

Purpose

We assessed the performance of different continuous positive airway pressure (CPAP) helmets equipped with a safety valve during discontinuation of fresh gas flow.

Methods

This was a physiological study of five healthy volunteers. We delivered CPAP (fresh gas flow 60 l/min, FiO2 60%, PEEP 5 cmH2O) with three different helmets in a random sequence: 4Vent (Rüsch), HelmHAR-cp (Harol) and CaStar CP210 (StarMed). For each helmet we randomly applied, for up to 4 min, three disconnections of fresh gas flow: helmet inlet (Dinlet), flowmeter (Dflowmeter) and gas source (Dsource). We continuously recorded from a nostril: end-tidal CO2 (PetCO2), inspiratory CO2 (PiCO2), fraction of inspired oxygen (FiO2) and respiratory rate (RR).

Results

During every disconnection we observed an increase in PiCO2 and PetCO2 with a drop in FiO2, while RR did not change. FiO2 decreased more quickly in the CaStar, equipped with the largest safety valve, during Dsource and Dflowmeter, while FiO2 decreased more quickly during Dinlet in CaStar and in 4Vent. PiCO2 resulted in a lower increase in CaStar during Dsource and Dflowmeter compared to 4Vent. PetCO2 in CaStar increases more slowly compared to 4Vent during Dsource and more slowly compared to the other two helmets during Dflowmeter. During Dinlet similar degrees of CO2 rebreathing and PetCO2 were recorded among all the helmets.

Conclusions

To minimize CO2 rebreathing during disconnection of the fresh gas supply while performing helmet CPAP, it is desirable to utilize large helmets with a large anti-suffocation valve. Monitoring and alarm systems should be employed for safe application of helmet CPAP.

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Authors and Affiliations

  1. Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza, MB, Italy

    Manuela Milan, Antonio Pesenti & Nicolò Patroniti

  2. Department of Experimental Medicine, University of Milan-Bicocca, Via Cadore 48, Monza, MB, Italy

    Alberto Zanella, Stefano Isgrò, Salua Abd El Aziz El Sayed Deab, Federico Magni, Antonio Pesenti & Nicolò Patroniti

  3. Ospedale San Gerardo, Via Donizetti 106, 20052, Monza, Milan, Italy

    Nicolò Patroniti

Authors
  1. Manuela Milan
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  2. Alberto Zanella
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  3. Stefano Isgrò
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  4. Salua Abd El Aziz El Sayed Deab
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  5. Federico Magni
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  6. Antonio Pesenti
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  7. Nicolò Patroniti
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Corresponding author

Correspondence to Nicolò Patroniti.

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Milan, M., Zanella, A., Isgrò, S. et al. Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply. Intensive Care Med 37, 1031–1035 (2011). https://doi.org/10.1007/s00134-011-2207-3

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  • DOI: https://doi.org/10.1007/s00134-011-2207-3

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