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Indian Pediatr 2018;55: 165 -166 |
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Feasibility of
Helmet-delivered Continous Positive Airway Pressure in
Very Low Birthweight Infants
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*Almudena Alonso-Ojembarrena, Antonio Segado-Arenas,
Isabel Benavente-Fernández and
Simón Pedro Lubián-López
Department of Pediatrics, Neonatal Intensive Care Unit,
Puerta del Mar University Hospital, Cádiz (Spain).
E-mail: [email protected]
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We describe our experience with helmet-delivered continuous positive
airway pressure in five preterm newborns. We analyzed oxygen
requirement, arterial oxygen saturation, respiratory rate, medium
arterial pressure, heart rate, apneic spells and patient’s comfort. The
patients’ vital signs or pain scale were not different before and after
treatment.
Keywords: CPAP, Noninvasive ventilation, Prematurity,
Respiratory distress syndrome.
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H
elmet-delivered continuous
positive airway pressure (CPAP) is a different interface for the
delivery of CPAP when nasal CPAP (nCPAP) is contraindicated as in cleft
lip or palate, or in patients with nasal lesions. The Gregory box,
developed in the late Sixties, is clearly the forerunner of this helmet
[1]. The purpose of this paper is to describe our experience with
helmet-delivered CPAP in five very low birth weight (VLBW) infants.
The Infant-Low helmet (CaStar; Starmed, Mirandola,
Italy) is made of a clear latex-free flexible material. It is fastened
by a harness called ‘baby-body’ that is connected to an elastic collar
ensuring a good seal without compression of the patient’s body; in
preterm infants, this collar surrounds the body next to the armpits. The
input port is connected to an air-oxygen mixer that enables the
determination of the desired flow and fraction of inspired oxygen and
the output port is connected to a positive end-expiratory pressure valve
that allows the regulation of the CPAP level. According to
manufacturer’s recommen-dations, we used an input flow of >20 Lpm to
avoid CO 2
rebreathing [2,3]. We used a mean CPAP of 7 cmH2O
(95% CI 5.5-8.5 cmH2O). We
measured transcutaneous oxygen saturation, heart rate, non-invasive mean
blood pressure, respiratory rate and the Neonatal Infant Pain Scale
(NIPS) score [4], nine hours before helmet-delivered CPAP and nine hours
after. All parents consented to inclusion of their children’s data in
the study.
All patients were neonates born at 32 weeks of
gestational age or less, and VLBW at birth; none of them showed signs of
pain or discomfort. All responded well to treatment, which enabled CPAP
discontinuation in 48-72 hours. The median age at initiation of Helmet
device was 4.5 weeks. All patients survived till discharge; none of them
developed intraventricular hemorrhage (IVH) or white matter disease, and
just one was diagnosed as grade II retinopathy of prematurity. Hearing
tests were normal in all patients at discharge.
Helmet devices have been tested previously in preterm
infants [5], but has not been used in VLBW infants. An earlier study in
preterm infants suggested that use of Helmet CPAP reduces cerebral blood
flow in the immature brain and could potentially increase the risk of
IVH [6]: that is why we used it only after the acute phase of
respiratory instability, when the risk for IVH is very low. High noise
levels are also a concern in preterm patients, but as published earlier,
noise levels are in an acceptable range using earmuffs and filters [7].
The principal limitations of the device are the difficulty to access
infants for suction or manipulation, and that it lacks an alarm system
when there is loss of pressure inside the chamber.
In conclusion, Helmet CPAP could be an option in
newborns when nCPAP is contraindicated.
Contributors: AA-O, AS-A: provided medical
treatment to patients described, and manuscript writing; IB-F: provided
medical treatment to patients described in the manuscript, and
manuscript reviewing; SPL-L: conceptualized the study and manuscript
reviewing.
Funding: None; Competing interest: None
stated.
References
1. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH,
Hamilton WK. Treatment of the idiopathic respiratory distress syndrome
with continuous positive airway pressure. N Engl J Med.
1971~284:1333-40.
2. Taccone P, Hess D, Caironi P, Bigatello LM.
Continuous positive airway pressure delivered with a "helmet": effects
on carbon dioxide rebreathing. Crit Care Med. 2004;32:2090-6.
3. Racca F, Appendini L, Gregoretti C, Varese I,
Berta G, Vittone F, et al. Helmet ventilation and carbon dioxide
rebreathing: effects of adding a leak at the helmet ports. Intensive
Care Med. 2008;34:1461-8.
4. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray
SB, Dulberg C. The development of a tool to assess neonatal pain.
Neonatal Netw. 1993;12:59-66.
5. Trevisanuto D, Grazzina N, Doglioni N, Ferrarese
P, Marzari F, Zanardo V. A new device for administration of continuous
positive airway pressure in preterm infants: comparison with a standard
nasal CPAP continuous positive airway pressure system. Intensive Care
Med. 2005;31:859-64.
6. Zaramella P, Freato F, Grazzina N, Saraceni E,
Vianello A, Chiandetti L. Does helmet CPAP reduce cerebral blood flow
and volume by comparison with Infant Flow driver CPAP in preterm
neonates? Int Care Med. 2006;32: 1613-9.
7. 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. 2017;19:20-3.
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