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I’m excited to share a project I’ve been working on to facilitate #helmet interface non-invasive ventilation for people with respiratory failure due to #COVID19. This thread is a brief #tweetorial on helmet interface ventilation.
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Projections show that in a severe/continuing pandemic, the # of people requiring MV may exceed available vents. It’s not just the vents but a shortage of medications used to keep pts comfortable on the vent and personnel who know how to safely use them. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30315-7/fulltext
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So what can be done? One thought is to build more vents, but that’s easier said than done: vents are complex, highly regulated devices. Despite lots of enthusiasm it's not easy/quick to ramp up vent production. It also doesn't fix medication shortages.
https://www.npr.org/2020/03/31/824886286/episode-987-the-race-to-make-ventilators
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https://www.npr.org/2020/03/31/824886286/episode-987-the-race-to-make-ventilators
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Not only are ventilators resource intensive, but patients with #COVID19 who are sick enough to require invasive ventilation often do poorly. This is more a correlation w/ disease severity rather caused by IMV per se. That said, what if we could avoid intubating COVID pts?
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Several studies (and meta-analyses) have shown that in patients with hypoxemic respiratory failure we can avoid intubation by using non-invasive positive pressure ventilation (NIPPV). This can also potentially reduce ICU mortality. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297344/
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297344/5/
We also know NIPPV works for coronavirus: In the 2004 SARS outbreak, one group used NIPPV to avoid intubation in 70% of cases (n=14) and pts treated with NIPPV had shorter ICU LOS (3.1 vs 21.3 days). Importantly, none of the 105 HCWs exposed got SARS. https://journal.chestnet.org/article/S0012-3692(15)31228-9/pdf
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https://journal.chestnet.org/article/S0012-3692(15)31228-9/pdf 6/
Unfortunately, there are two big challenges to using #NIPPV in patients with ARDS due to #COVID.
1. Many patients don’t tolerate wearing a tight-fitting mask for days &
2. Air leak around the mask may aerosolize a significant amount of virus, potentially placing HCWs at risk
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1. Many patients don’t tolerate wearing a tight-fitting mask for days &
2. Air leak around the mask may aerosolize a significant amount of virus, potentially placing HCWs at risk
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This is where helmet ventilation comes in. Instead of a tight fitting face mask think Apollo astronaut. The helmet interface forms a transparent bubble around the patient’s head and forms a tight seal w/ valves around the collar. This is more comfortable and better tolerated.
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