Helmet Continuous Positive Airway Pressure in the Emergency Department: A Practical Guide

Continuous positive airway pressure; Emergency department; Flow; Noise; Noninvasive ventilation; Respiratory insufficiency; Continuous Positive Airway Pressure; COVID-19; Emergency Service, Hospital; Head Protective Devices; Humans; Pandemics; Respiratory Insufficiency; continuous positive airway pressure; coronavirus disease 2019; hospital emergency service; human; pandemic; respiratory failure

Abstract :

[en] Helmet continuous positive airway pressure is a simple, noninvasive respiratory support strategy to treat several forms of acute respiratory failure, such as cardiogenic pulmonary edema and pneumonia. Recently, it has been largely used worldwide during the COVID-19 pandemic. Given the increased use of helmet continuous positive airway pressure in the emergency department, we aimed to provide an updated practical guide for nurses and clinicians based on the latest available evidence. We focus our attention on how to set the respiratory circuit. Moreover, we discuss the interactions between flow generators, filters, and positive end-expiratory pressure valves and the consequences regarding the delivered gas flow, fraction of inspired oxygen, positive end-expiratory pressure, and noise level. © 2023 Emergency Nurses Association

Disciplines :

Nursing Science

Author, co-author :

PRIVITERA, Daniele ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) > Medical Education

Capsoni, Nicolò

Bellone, Andrea

Langer, Thomas

External co-authors :

Language :

English

Title :

Helmet Continuous Positive Airway Pressure in the Emergency Department: A Practical Guide

Publication date :

2023

Journal title :

Journal of Emergency Nursing

ISSN :

0099-1767

eISSN :

1527-2966

Publisher :

Elsevier Inc.

Volume :

Issue :

Pages :

661 - 665

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBilu :

since 26 November 2025

Statistics

Number of views

0 (0 by Unilu)

Number of downloads

0 (0 by Unilu)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Weng, C.L., Zhao, Y.T., Liu, Q.H., et al. Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med 152:20 (2010), 590–600, 10.7326/0003-4819-152-9-201005040-00009.
Collins, S.P., Mielniczuk, L.M., Whittingham, H.A., Boseley, M.E., Schramm, D.R., Storrow, A.B., The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review. Ann Emerg Med 48:3 (2006), 260–269.e2694, 10.1016/j.annemergmed.2006.01.038.
Berbenetz, N., Wang, Y., Brown, J., et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev, 2019(4), 2019, CD005351, 10.1002/14651858.CD005351.pub4.
Bellone, A., Vettorello, M., Monari, A., Cortellaro, F., Coen, D., Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema. Intensive Care Med 31:6 (2005), 807–811, 10.1007/s00134-005-2649-6.
Cosentini, R., Brambilla, A.M., Aliberti, S., et al. Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial. Chest 138:1 (2010), 114–120, 10.1378/chest.09-2290.
Ferrer, M., Esquinas, A., Leon, M., Gonzalez, G., Alarcon, A., Torres, A., Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:12 (2003), 1438–1444, 10.1164/rccm.200301-072OC.
Patel, B.K., Wolfe, K.S., Pohlman, A.S., Hall, J.B., Kress, J.P., Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome a randomized clinical trial. JAMA 315:22 (2016), 2435–2441, 10.1001/jama.2016.6338.
Coppadoro, A., Benini, A., Fruscio, R., et al. Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak. Crit Care 25:1 (2021), 1–10, 10.1186/s13054-021-03502-y.
Bellani, G., Grasselli, G., Cecconi, M., et al. Noninvasive ventilatory support of patients with Covid-19 outside the intensive care units (ward-covid). Ann Am Thorac Soc 18:6 (2021), 1020–1026, 10.1513/AnnalsATS.202008-1080OC.
Cammarota, G., Esposito, T., Azzolina, D., et al. Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis. Crit Care, 25(1), 2021, 268, 10.1186/s13054-021-03697-0.
Privitera, D., Capsoni, N., Mazzone, A., et al. Nursing evaluation during treatment with helmet continuous positive airway pressure in patients with respiratory failure due to COVID-19 pneumonia: a case series. Aust Crit Care 35:1 (2022), 46–51, 10.1016/j.aucc.2021.10.001.
Crimi, C., Noto, A., Princi, P., Esquinas, A., Nava, S., A European survey of noninvasive ventilation practices. Eur Respir J 36:2 (2010), 362–369, 10.1183/09031936.00123509.
Chiumello, D., Pelosi, P., Carlesso, E., et al. Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive Care Med 29:10 (2003), 1671–1679, 10.1007/s00134-003-1825-9.
Patroniti, N., Saini, M., Zanella, A., Isgrò, S., Pesenti, A., Danger of helmet continuous positive airway pressure during failure of fresh gas source supply. Intensive Care Med 33:1 (2007), 153–157, 10.1007/s00134-006-0446-5.
Ferioli, M., Cisternino, C., Leo, V., Pisani, L., Palange, P., Nava, S., Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev, 29(155), 2020, 200068, 10.1183/16000617.0068-2020.
Lucchini, A., Giani, M., Winterton, D., Foti, G., Rona, R., Procedures to minimize viral diffusion in the intensive care unit during the COVID-19 pandemic. Intensive Crit Care Nurs, 60, 2020, 102894, 10.1016/j.iccn.2020.102894.
Adi, O., Via, G., Salleh, S.H., et al. Randomized clinical trial comparing helmet continuous positive airway pressure (hCPAP) to facemask continuous positive airway pressure (fCPAP) for the treatment of acute respiratory failure in the emergency department. Am J Emerg Med 49 (2021), 385–392, 10.1016/j.ajem.2021.06.031.
Privitera, D., Capsoni, N., Zadek, F., et al. The effect of filters on CPAP delivery by helmet. Respir Care 67:8 (2022), 995–1001, 10.4187/respcare.09822.
Bose, E., Hoffman, L., Hravnak, M., Monitoring cardiorespiratory instability: current approaches and implications for nursing practice. Intensive Crit Care Nurs 34 (2016), 12–19, 10.1016/j.iccn.2015.11.005.
Naughton, M.T., Rahman, M.A., Hara, K., Floras, J.S., Bradley, T.D., Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 91:6 (1995), 1725–1731, 10.1161/01.CIR.91.6.1725.
Coppadoro, A., Zago, E., Pavan, F., Foti, G., Bellani, G., The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings. Crit Care 25:1 (2021), 1–11, 10.1186/s13054-021-03746-8.
Isgrò, S., Zanella, A., Giani, M., Abd El Aziz El Sayed Deab, S., Pesenti, A., Patroniti, N., Performance of different PEEP valves and helmet outlets at increasing gas flow rates: a bench top study. Minerva Anestesiol 78:10 (2012), 1095–1100.
Lucchini, A., Elli, S., Bambi, S., et al. How different helmet fixing options could affect patients’ pain experience during helmet-continuous positive airway pressure. Nurs Crit Care 24:6 (2019), 369–374, 10.1111/nicc.12399.
Privitera, D., Mazzone, A., Vailati, P., Amato, R., Capsoni, N., Improving helmet CPAP use during COVID-19 pandemic: a multidisciplinary approach in the emergency department. Dimen Crit Care Nurs 41:4 (2022), 178–181, 10.1097/dcc.0000000000000534.
Pisani, L., Carlucci, A., Nava, S., Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency. Minerva Anestesiol 78:10 (2012), 1154–1161.
British Thoracic Society Standards of Care Committee, Non-invasive ventilation in acute respiratory failure. Thorax 57:3 (2002), 192–211, 10.1136/thorax.57.3.192.
Brusasco, C., Corradi, F., De Ferrari, A., Ball, L., Kacmarek, R.M., Pelosi, P., CPAP devices for emergency prehospital use: a bench study. Respir Care 60:12 (2015), 1777–1785, 10.4187/respcare.04134.
Privitera, D., Angaroni, L., Capsoni, N., et al. Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department. Intern Emerg Med 15:5 (2020), 767–771, 10.1007/s11739-020-02370-8.
Lucchini, A., Giani, M., Minotti, D., Elli, S., Bambi, S., Helmet CPAP bundle: a narrative review of practical aspects and nursing interventions to improve patient's comfort. Intensive Crit Care Nurs, 74, 2023, 103335, 10.1016/j.iccn.2022.103335.
Rezoagli, E., Coppola, G., Dezza, L., et al. High efficiency particulate air filters and heat & moisture exchanger filters increase positive end-expiratory pressure in helmet continuous positive airway pressure: a bench-top study. Pulmonology S2531-0437:22 (2022), 00125–00128, 10.1016/j.pulmoe.2022.05.003.
Nishimura, M., High-flow nasal cannula oxygen therapy devices. Respir Care 64:6 (2019), 735–742, 10.4187/respcare.06718.
Privitera, D., Capsoni, N., Zadek, F., et al. Flow generators for helmet CPAP: which to prefer? A bench study. Intensive Crit Care Nurs, 74, 2023, 103344, 10.1016/j.iccn.2022.103344.
Lucchini, A., Bambi, S., Gurini, S., et al. Noise level and comfort in healthy subjects undergoing high-flow helmet continuous positive airway pressure. Dimen Crit Care Nurs 39:4 (2020), 194–202, 10.1097/DCC.0000000000000430.
Hernández-Molina, R., Fernández-Zacarías, F., Benavente-Fernández, I., Jiménez-Gómez, G., Lubián-López, S., Effect of filters on the noise generated by continuous positive airway pressure delivered via a helmet. Noise Health 19:86 (2017), 20–23, 10.4103/1463-1741.199237.
Cabrini, L., Landoni, G., Zangrillo, A., Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure. Lancet, 395(10225), 2020, 685, 10.1016/S0140-6736(20)30359-7.