Resuscitators call it a ‘helmet’ and it is a strange tool that allows patients with severe respiratory failure, such as those with pneumonia Covid-19, to breathe. The helmet was invented and is produced in Italy, and it is almost only Italian resuscitators who use it. But now, a study just published in the scientific journal Jama claims that the ‘Italian way’ to non-invasive respiratory support – the ‘helmet’ in fact – can be the winning one in patients with Covid-19 because it reduces the need to resort to intubation by 40%, compared to high-flow oxygen therapy, which is considered the optimal respiratory support in case of hypoxemia.
The main reason for hospitalization in resuscitation of patients with Covid-19 is theacute respiratory failure, caused by pneumonia. Domenico Luca Grieco e Massimo Antonelli (for the COVID-ICU Gemelli Study Group), authors of the work just published on JAMA suggest, through the results of the HENIVOT study, that the helmet could be the best way to ‘breathe’ these patients, reducing the need for intubation and invasive mechanical ventilation.
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“The helmet is an all-Italian approach. Its use is not frequent abroad – says the doctor Domenico Luca Grieco, resuscitator at the Intensive Care Unit of Columbus Covid2 Hospital-Fondazione Policlinico Universitario Agostino Gemelli IRCCS – while high flow oxygen therapy has so far been considered the gold standard for these patients (as indicated by the 2020 guidelines for patients with severe hypoxemia). The ‘helmet’ (or helmet) was used a lot during this pandemic, but mainly in Italy and the great merit of this study is that it represents the first documentation of the effectiveness of the ‘helmet’ with respect to high flow oxygen therapy, which is a very simple tool to use and is widespread in all ICUs in the world “.
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The helmet is a different way to help patients, because it allows to deliver very high pressures that allow to ‘reopen’ the lung affected by the inflammatory process and reduce the respiratory fatigue of these patients. “Studies conducted in the past have shown that the use of these high pressures protects the lung from further damage during ventilation. Furthermore, the helmet is very comfortable compared to other interfaces for non-invasive ventilation: this allows for continuous treatments with few interruptions. which would seem to be a fundamental feature to avoid intubation. In this work we compared the effects of high flow oxygen therapy with those of the helmet. And the results show that the helmet allows to avoid the use of invasive ventilation (intubation) in about 40% more patients “, adds Grieco. But helmet-treated patients must be closely monitored, because when intubation becomes necessary, it should not be delayed, as doing so would increase mortality.
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“These are promising results, the result of work conducted in an emergency context, and lead us to hypothesize that the use of helmets, although it requires very experienced personnel and specific settings, can be considered in protected contexts and can improve the therapy of affected patients. from COVID-19 and, more generally, from hypoxemic respiratory failure ”, adds Grieco.
The publication on Jama is accompanied by an editorial that actually opens the use of this method and identifies the novelty of the study. Grieco was keen to remember that the results of the study will be confirmed by research on a higher number of patients.
The HENIVOT study was conducted between October 2020 and February 2021 on 109 patients enrolled in some Italian intensive care units and has shown that the helmet is the best performing system to assist patients with acute respiratory failure due to Covid-19. It was the Italian resuscitators that first adopted this type of ventilatory support during the Covid pandemic, which is all made in Italy.
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