Racca F, Appendini L, Gregoretti C, Varese I, Berta G, Vittone F, Ferreyra G, Stra E, Ranieri VM. Helmet ventilation and carbon dioxide rebreathing: effects of adding a leak at the helmet ports.
Intensive Care Med 2008;
34:1461-8. [PMID:
18458874 DOI:
10.1007/s00134-008-1120-x]
[Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 03/24/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE
We examined whether additional helmet flow obtained by a single-circuit and a modified plateau valve applied at the helmet expiratory port (open-circuit ventilators) improves CO(2) wash-out by increasing helmet airflow.
DESIGN AND SETTING
Randomized physiological study in a university research laboratory.
PARTICIPANTS
Ten healthy volunteers.
INTERVENTIONS
Helmet continuous positive airway pressure and pressure support ventilation delivered by an ICU ventilator (closed-circuit ventilator) and two open-circuit ventilators equipped with a plateau valve placed either at the inspiratory or at the helmet expiratory port.
MEASUREMENTS AND RESULTS
We measured helmet air leaks, breathing pattern, helmet minute ventilation (Eh)), minute ventilation washing the helmet (Ewh)), CO(2) wash-out, and ventilator inspiratory assistance. Air leaks were small and similar in all conditions. Breathing pattern was similar among the different ventilators. Inspiratory and end-tidal CO(2) were lower, while (Eh) and (Ewh) were higher only using open-circuit ventilators with the plateau valve placed at the helmet expiratory port. This occurred notwithstanding these ventilators delivered a lower inspiratory assistance.
CONCLUSIONS
Additional helmet flow provided by open-circuit ventilators can lower helmet CO(2) rebreathing. However, inspiratory pressure assistance significantly decreases using open-circuit ventilators, still casting doubts on the choice of the optimal helmet ventilation setup.
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