Flow generators for helmet CPAP: Which to prefer? A bench study

Continuous positive airway pressure; Emergency department; Filter; Helmet; Noise; Non-invasive ventilation; Respiratory insufficiency; Continuous Positive Airway Pressure; Humans; human; noise; positive end expiratory pressure ventilation

Abstract :

[en] Objective: To assess the different effect of filters’ application during helmet-CPAP delivered with three different flow generators on the delivered fresh gas flow, FiO2, and the noise level inside and outside the helmet. Methods: In a bench study, three flow generators (air-oxygen blender, turbine ventilator and Venturi system) were used to generate two different gas flows (60 L/min and 80 L/min), with a fixed FiO2 at 0.6, to perform a helmet-CPAP on a manikin. Three different fixed PEEP valves (7.5, 10, and 12.5 cmH2O) were applied at the expiratory port. Gas flow, FiO2 and noise were recorded for each Flow-generator/Flow/PEEP combination, first without filter interposition and then after positioning a heat and moister exchanger filter (HMEF) at the helmet inlet port. Results: The application of the HMEF lead to a significant difference in the flow variation among the three flow generators (p < 0.001). Compared to baseline, the highest flow reduction was observed with the VENTURI (−13.4 ± 1.2 %, p < 0.001), a slight increase with the BLENDER (1.2 ± 0.5 %, p < 0.001), whereas no difference was recorded with the TURBINE (0.1 ± 0.6 %, p = 0.12). After HMEF was interposed, a significant FiO2 variation was observed only with VENTURI (11.3 ± 1.8 %, p < 0.001). As for the noise, the TURBINE was the least noisy system, both with and without the filter interposition. Conclusions: Flow generators used to deliver helmet-CPAP have different characteristics and responses to HMEF interposition. Users should be aware of the effects on FiO2 and flow of the different devices in order to make a precise setup of the circuit. © 2022 Elsevier Ltd

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 ; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Capsoni, Nicolò; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Zadek, Francesco; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy ; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca’ Granda, Milan, Italy

Mazzone, Annamaria; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Bellone, Andrea; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

Fumagalli, Roberto; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy ; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca’ Granda, Milan, Italy

Langer, Thomas; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy ; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca’ Granda, Milan, Italy

External co-authors :

Language :

English

Title :

Flow generators for helmet CPAP: Which to prefer? A bench study

Publication date :

2023

Journal title :

Intensive and Critical Care Nursing

ISSN :

0964-3397

eISSN :

1532-4036

Publisher :

Churchill Livingstone

Volume :

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBilu :

since 26 November 2025

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Bibliography

Amirfarzan, H., Cereda, M., Gaulton, T.G., Leissner, K.B., Cortegiani, A., Schumann, R., Gregoretti, C., Use of Helmet CPAP in COVID-19 – A practical review. Pulmonology 27:5 (2021), 413–422, 10.1016/j.pulmoe.2021.01.008.
Bellani, G., Patroniti, N., Greco, M., Foti, G., Presenti, A., The use of helmets to deliver non-invasive continuous positive airway pressure in hypoxemic acute respiratory failure. Minerva Anestesiol. 74:11 (2008), 651–656.
Bellani, G., Grasselli, G., Cecconi, M., Antolini, L., Borelli, M., De Giacomi, F., Bosio, G., Latronico, N., Filippini, M., Gemma, M., Giannotti, C., Antonini, B., Petrucci, N., Zerbi, S.M., Maniglia, P., Castelli, G.P., Marino, G., Subert, M., Citerio, G., Radrizzani, D., Mediani, T.S., Lorini, F.L., Russo, F.M., Faletti, A., Beindorf, A., Covello, R.D., Greco, S., Bizzarri, M.M., Ristagno, G., Mojoli, F., Pradella, A., Severgnini, P., Da Macallè, M., Albertin, A., Ranieri, V.M., Rezoagli, E., Vitale, G., Magliocca, A., Cappelleri, G., Docci, M., Aliberti, S., Serra, F., Rossi, E., Valsecchi, M.G., Pesenti, A., Foti, G., Noninvasive ventilatory support of patients with covid-19 outside the intensive care units (ward-covid). Ann. Am. Thoracic Soc. 18:6 (2021), 1020–1026.
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.
Berglund, B., Lindvall, T., Schwela, D.H., New who guidelines for community noise. Noise Vibr. Worldwide 31:4 (2000), 24–29, 10.1260/0957456001497535.
Brambilla, A.M., Aliberti, S., Prina, E., Nicoli, F., Forno, M.D., Nava, S., Ferrari, G., Corradi, F., Pelosi, P., Bignamini, A., Tarsia, P., Cosentini, R., Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med. 40:7 (2014), 942–949, 10.1007/s00134-014-3325-5.
Brusasco, C., Corradi, F., De Ferrari, A., Ball, L., Kacmarek, R.M., Pelosi, P., CPAP devices for emergency prehospital use: a bench study. Respiratory Care 60:12 (2015), 1777–1785, 10.4187/respcare.04134.
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.
Cavaliere, F., Conti, G., Costa, R., Proietti, R., Sciuto, A., Masieri, S., Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask. Intensive Care Med. 30:9 (2004), 1755–1760, 10.1007/s00134-004-2347-9.
Cavaliere, F., Conti, G., Costa, R., Spinazzola, G., Proietti, R., Sciuto, A., Masieri, S., Exposure to noise during continuous positive airway pressure: Influence of interfaces and delivery systems. Acta Anaesthesiol. Scand. 52:1 (2008), 52–56, 10.1111/j.1399-6576.2007.01474.x.
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.e4.
Coppadoro, A., Benini, A., Fruscio, R., Verga, L., Mazzola, P., Bellelli, G., Carbone, M., Mulinacci, G., Soria, A., Noè, B., Beck, E., Di Sciacca, R., Ippolito, D., Citerio, G., Valsecchi, M.G., Biondi, A., Pesci, A., Bonfanti, P., Gaudesi, D., Foti, G., 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.
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.
Cosentini, R., Brambilla, A.M., Aliberti, S., Bignamini, A., Nava, S., Maffei, A., Martinotti, R., Tarsia, P., Monzani, V., Pelosi, P., 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.
Isgrò, S., Zanella, A., Giani, M., El Aziz, A., El Sayed, D.E.A.B., Pesenti, A., Patroniti, N., Performance of different PEEP valves and helmet outlets at increasing gas fow rates: A bench top study. Minerva Anestesiol. 78:10 (2012), 1095–1100.
L'Her, E., Deye, N., Lellouche, F., Taille, S., Demoule, A., Fraticelli, A., Mancebo, J., Brochard, L., Physiologic effects of noninvasive ventilation during acute lung injury. Am. J. Respir. Crit. Care Med. 172:9 (2005), 1112–1118, 10.1164/rccm.200402-226OC.
L'Her, E., Roy, A., Marjanovic, N., Bench-test comparison of 26 emergency and transport ventilators. Crit. Care 18:5 (2014), 1–14, 10.1186/s13054-014-0506-0.
Lucchini, A., Bambi, S., Gurini, S., Di Francesco, E., Pace, L., Rona, R., Fumagalli, R., Foti, G., Elli, S., Noise level and comfort in healthy subjects undergoing high-flow helmet continuous positive airway pressure. Dimens. Crit. Care Nurs. 39:4 (2020), 194–202, 10.1097/DCC.0000000000000430.
Lucchini, A., Giani, M., Isgrò, S., Rona, R., Foti, G., The “helmet bundle” in COVID-19 patients undergoing non invasive ventilation. Intensive Crit. Care Nurs., 58, 2020, 102859, 10.1016/j.iccn.2020.102859.
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.
Masa, J.F., Mokhlesi, B., Benítez, I., Gomez de Terreros, F.J., Sánchez-Quiroga, M.Á., Romero, A., Caballero-Eraso, C., Terán-Santos, J., Alonso-Álvarez, M.L., Troncoso, M.F., González, M., López-Martín, S., Marin, J.M., Martí, S., Díaz-Cambriles, T., Chiner, E., Egea, C., Barca, J., Vázquez-Polo, F.-J., Negrín, M.A., Martel-Escobar, M., Barbe, F., Corral, J., Fernández, G., Ordax-Carbajo, E., González-Mangado, N., Gómez-García, T., Martínez-Martínez, M.-Á., Ojeda-Castillejo, E., López Padilla, D., Carrizo, S.J., Gallego, B., Pallero, M., Romero, O., Ramón, M.A., Arias, E., Muñoz-Méndez, J., Senent, C., Sancho-Chust, J.N., Navarro Soriano, N.B., Barrot, E., Benítez, J.M., Sánchez-Gómez, J., Golpe, R., Santiago-Recuerda, A., Gómez, S., Bengoa, M., Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. Lancet 393:10182 (2019), 1721–1732.
Masip, J., Noninvasive ventilation in acute heart failure. Curr. Heart Failure Rep. 16:4 (2019), 89–97, 10.1007/s11897-019-00429-y.
Nishimura, M., High-flow nasal cannula oxygen therapy devices. Respiratory Care 64:6 (2019), 735–742, 10.4187/respcare.06718.
Orellana, D., Busch-Vishniac, I.J., West, J.E., Noise in the adult emergency department of Johns Hopkins Hospital. J. Acoust. Soc. Am. 121:4 (2007), 1996–1999, 10.1121/1.2642309.
Patroniti, N., Foti, G., Manfio, A., Coppo, A., Bellani, G., Pesenti, A., Head helmet versus face mask for non-invasive continuous positive airway pressure: A physiological study. Intensive Care Med. 29:10 (2003), 1680–1687, 10.1007/s00134-003-1931-8.
Pisani, L., Carlucci, A., Nava, S., Interfaces for noninvasive mechanical ventilation: Technical aspects and efficiency. Minerva Anestesiol. 78:10 (2012), 1154–1161.
Privitera, D., Angaroni, L., Capsoni, N., Forni, E., Pierotti, F., Vincenti, F., Bellone, A., Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department. Intern. Emerg. Med. 15:5 (2020), 767–771.
Privitera, D., Capsoni, N., Mazzone, A., Airoldi, C., Angaroni, L., Pierotti, F., Rocca, E., Dal Molin, A., Bellone, A., Nursing evaluation during treatment with helmet continuous positive airway pressure in patients with respiratory failure due to COVID-19 pneumonia: A case series. Austral. Critical Care 35:1 (2022), 46–51, 10.1016/j.aucc.2021.10.001.
Privitera, D., Capsoni, N., Zadek, F., Vailati, P., Airoldi, C., Cozzi, M., Pierotti, F., Fumagalli, R., Bellone, A., Langer, T., The effect of filters on CPAP delivery by helmet. Respiratory Care 67:8 (2022), 995–1001.
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. Dimens. Crit. Care Nurs., 41(4), 2022 https://journals.lww.com/dccnjournal/Fulltext/2022/07000/Improving_Helmet_CPAP_Use_During_COVID_19.4.aspx.
Rezoagli, E., Coppola, G., Dezza, L., Galesi, A., Gallo, G.P., Fumagalli, R., Bellani, G., Foti, G., Lucchini, A., 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 000:xxxx (2022), 1–9, 10.1016/j.pulmoe.2022.05.003.
Rochwerg, B., Brochard, L., Elliott, M.W., Hess, D., Hill, N.S., Nava, S., Navalesi, P., Antonelli, M., Brozek, J., Conti, G., Ferrer, M., Guntupalli, K., Jaber, S., Keenan, S., Mancebo, J., Mehta, S., Raoof, S., Official ERS/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure. Eur. Respir. J., 50(2), 2017, 1602426.
Taccone, P., Hess, D., Caironi, P., Bigatello, L.M., Continuous positive airway pressure delivered with a “helmet”: Effects on carbon dioxide rebreathing. Crit. Care Med. 32:10 (2004), 2090–2096, 10.1097/01.CCM.0000142577.63316.C0.
Tijunelis, M.A., Fitzsullivan, E., Henderson, S.O., Noise in the ED. Am. J. Emerg. Med. 23:3 (2005), 332–335, 10.1016/j.ajem.2005.02.037.
Vital, F.M.R., Atallah, Á.N., Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Datab. System. Rev., 5, 2013, 10.1002/14651858.CD005351.pub3.
Weng, C.L., Zhao, Y.T., Liu, Q.H., et al., M. N. ventilation in acute cardiogenic pulmonary edema [published correction appears in A. I. M. 2010 A. 17;153(4):280] [published correction appears in A. I. M. 2010 J. 6;153(1):67]. A. I. M. (2010). Review Annals of Internal Medicine Meta-analysis: Noninvasive Ventilation in Acute Cardiogenic Pulmonary. Ann. Internal Med., 152(20), 590–600.