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Review
. 2021 Sep-Oct;27(5):413-422.
doi: 10.1016/j.pulmoe.2021.01.008. Epub 2021 Feb 1.

Use of Helmet CPAP in COVID-19 - A practical review

H Amirfarzan  1 , M Cereda  2 , T G Gaulton  3 , K B Leissner  4 , A Cortegiani  5 , R Schumann  6 , C Gregoretti  7
Affiliations
Review

Use of Helmet CPAP in COVID-19 - A practical review

H Amirfarzan et al. Pulmonology. 2021 Sep-Oct.

Abstract

Helmet CPAP (H-CPAP) has been recommended in many guidelines as a noninvasive respiratory support during COVID-19 pandemic in many countries around the world. It has the least amount of particle dispersion and air contamination among all noninvasive devices and may mitigate the ICU bed shortage during a COVID surge as well as a decreased need for intubation/mechanical ventilation. It can be attached to many oxygen delivery sources. The MaxVenturi setup is preferred as it allows for natural humidification, low noise burden, and easy transition to HFNC during breaks and it is the recommended transport set-up. The patients can safely be proned with the helmet. It can also be used to wean the patients from invasive mechanical ventilation. Our article reviews in depth the pathophysiology of COVID-19 ARDS, provides rationale of using H-CPAP, suggests a respiratory failure algorithm, guides through its setup and discusses the issues and concerns around using it.

Keywords: ARDS; COVID-19; Helmet; Non-invasive mechanical ventilation; Respiratory failure.

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Figures

Figure 1
Figure 1
O2 delivery system configuration.
Figure 2
Figure 2
Flow delivery system configuration: MAX VENTURI System connected to a helmet. A: A MAX VENTURI system is provided with 2 knobs to independently set oxygen and air. Knob (A) regulates oxygen percentage, Knob (B) regulates air, (C) oxygen cell and read on the display (D). protected by a HEPA filter (E). The outlet of the venturi system is connected to the inlet port (G) of the water chamber of an active humidifier (H) through an insulated circuit (F) From the outlet port of the water chamber another insulated circuit (I) connects the helmet inlet port as shown in B. B: A MAX VENTURI system is connected to the helmet (L) inlet port (M) through an insulated circuit (I) coming from the water chamber of the humidifier (H). The expiratory helmet port (N), protected with a HEPA filter (Q), is provided with a PEEP valve (O). Two armpit braces (P) keep the helmet in place. MAX VENTURI can be coupled to an active humidifier.
Figure 3
Figure 3
H-CPAP Respiratory Failure Management Algorithm for COVID-19 Patients. The SpO2 goals are based off SCCM COVID recommendations. NC: Nasal Cannula; NRB: Non-Rebreather; ETT: Endotracheal intubation, ARF:acute respiratory failure, RR: respiratory rate
See this image and copyright information in PMC

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