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Continuous flow biphasic positive airway pressure by helmet in patients with acute hypoxic respiratory failure: effect on oxygenation.
MedLine Citation:
PMID:  20521025     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
PURPOSE: We investigated the effects of periodical high pressure breaths (SIGH) or biphasic positive pressure ventilation (BIPAP) during helmet continuous positive airway pressure (CPAP) in patients with acute hypoxic respiratory failure.
METHODS: We used a recently developed electromechanical expiratory valve (TwinPAP, StarMed, Mirandola, Italy), which is time-cycled between two customizable positive end-expiratory pressure (PEEP) levels. We studied 21 patients (67 ± 17 years old) undergoing helmet CPAP. Continuous flow CPAP system was set at 60 l/min flow rate while maintaining clinical FiO(2) (51 ± 15%). Five steps, lasting 1 h each, were applied: (1) spontaneous breathing with PEEP 0 cmH(2)O (SB), (2) CPAP with PEEP 8 cmH(2)O (CPAP(basal)), (3) low PEEP, 8 cmH(2)O, for 25 s and high PEEP, 25 cmH(2)O, for 5 s (SIGH), (4) low PEEP, 8 cmH(2)O, for 3 s and high PEEP, 20 cmH(2)O, for 3 s (BIPAP), (5) CPAP with PEEP 8 cmH(2)O (CPAP(final)). We randomized the sequence of SIGH and BIPAP.
RESULTS: PaO(2) was significantly higher during all steps compared to SB. When compared to CPAP(basal), both SIGH and BIPAP induced a further increase in PaO(2). PaO(2) during SIGH and BIPAP were not different. The oxygenation improvement was maintained during CPAP(final).
CONCLUSIONS: Superimposed, nonsynchronized positive pressure breaths delivered during helmet CPAP by means of the TwinPAP system may improve oxygenation in patients with acute hypoxemic respiratory failure, even at a rate as low as two breaths per minute.
Authors:
Stefano Isgrò; Alberto Zanella; Chiara Sala; Giacomo Grasselli; Giuseppe Foti; Antonio Pesenti; Nicolò Patroniti
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-03
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1688-94     Citation Subset:  IM    
Affiliation:
Department of Experimental Medicine, Azienda Ospedaliera San Gerardo, University of Milano-Bicocca, via Cadore 48, 20048 Monza (MI), Italy.
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