• Paolo Navalesi, Roberta Costa, Piero Ceriana, Annalisa Carlucci, George Prinianakis, Massimo Antonelli, Giorgio Conti, and Stefano Nava.
• Pneumologia Riabilitativa e Terapia Intensiva Respiratoria, Fondazione S. Maugeri IRCCS, Via S. Maugeri 10, 27100, Pavia, Italy. paolo.navalesi@fastwebnet.it
• Intensive Care Med. 2007 Jan 1;33(1):74-81.

RationaleThe helmet is a new interface with the potential of increasing the success rate of non-invasive ventilation by improving tolerance.ObjectivesTo perform a physiological comparison between the helmet and the conventional facial mask in delivering non-invasive ventilation in hypercapnic patients with chronic obstructive pulmonary disease.MethodsProspective, controlled, randomized study with cross-over design. In 10 patients we evaluated gas exchange, inspiratory effort, patient-ventilator synchrony and patient tolerance after 30 min of non-invasive ventilation delivered either by helmet or facial mask; both trials were preceded by periods of spontaneous unassisted breathing.MeasurementsArterial blood gases, inspiratory effort, duration of diaphragm contraction and ventilator assistance, effort-to-support delays (at the beginning and at the end of inspiration), number of ineffective efforts, and patient comfort.Main ResultsNon-invasive ventilation improved gas exchange (p<0.05) and inspiratory effort (p<0.01) with both interfaces. The helmet, however, was less efficient than the mask in reducing inspiratory effort (p<0.05) and worsened the patient-ventilator synchrony, as indicated by the longer delays to trigger on (p<0.05) and cycle off (p<0.05) the mechanical assistance and by the number of ineffective efforts (p<0.005). Patient comfort was no different with the two interfaces.ConclusionsHelmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort. The helmet, however, was less efficient in decreasing inspiratory effort and worsened the patient-ventilator interaction.

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