Non-Invasive Ventilation Via a Helmet Device for Patients Respiratory Failure
|Acute Respiratory Distress Syndrome Shock Ventilatory Failure Cardiogenic Pulmonary Edema||Device: Non invasive ventilation using a helmet hyperbaric device Other: Noninvasive ventilation via facemask|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Mechanical Ventilation in Patients With \Respiratory Failure: A Comparison of Face Mask and Non Invasive Ventilation Via a Helmet Device|
- Need for endotracheal intubation [ Time Frame: 6weeks ]Percentage of patients requiring endotracheal intubation after application of helmet device
- Hospital length of stay [ Time Frame: 6 weeks ]Days spent in hospital at time of enrollment
- Functional status after discharge [ Time Frame: Measured at 1, 6, and 12 months after hospital discharge (to span time frame of up to 80 weeks depending on length of hospitalization) ]Telephone survey of patients 1, 6, and 12 months after discharge to assess need for re-hospitalization, admission to nursing home, and functional status (ability to complete ADLs and IADLs independently)
- Ventilator days [ Time Frame: 2 weeks ]Duration of mechanical ventilation via endotracheal tube
- Hospital mortality [ Time Frame: 6 weeks ]Death from any cause during hospitalization at time of enrollment
- Intensive care unit length of stay [ Time Frame: 4 weeks ]Number of days admitted to a medical intensive care unit
- ICU complications [ Time Frame: 6 weeks ]ICU complications will include rates of Ventilator associated pneumonia, Barotrauma, Gastrointestinal hemorrhage, Pulmonary embolism, Sacral Decubitus ulcer, Delirium, ICU acquired weakness
- Readmission to the intensive care unit [ Time Frame: 6 weeks ]Measure the need for readmission to the intensive care unit during initial hospitalization at time of enrollment
- Discharge location [ Time Frame: 6 weeks ]Measure the location (ie home, rehabilitation center, nursing home) that patients are discharged to
- Improvement of oxygenation [ Time Frame: 2 weeks ]Improvement of oxygenation-defined as PaO2/FiO2 ≥ 200 or increase from baseline by 100
|Study Start Date:||September 2012|
|Estimated Study Completion Date:||June 2016|
|Estimated Primary Completion Date:||June 2016 (Final data collection date for primary outcome measure)|
Patients who require noninvasive ventilation via Face mask for more than 8 hours will continue using noninvasive ventilation via facemask.
Other: Noninvasive ventilation via facemask
Patients assigned to the conventional ventilation group will continue noninvasive ventilation via facemask
Other Name: mechanical ventilation
Experimental: Non invasive ventilation via helmet
Patients requiring more than 8 hours of noninvasive ventilation via facemask will switch to non-invasive ventilation using a helmet instead of face mask for treatment of respiratory failure
Device: Non invasive ventilation using a helmet hyperbaric device
Patients randomized to the intervention group will receive noninvasive ventilation delivered via a latex-free helmet connected to the ventilator by conventional tubing.
If endotracheal intubation is required, the helmet will be removed and the patient will be intubated without delay.
Other Name: Sea-Long medical treatment hood
Respiratory failure is often treated with endotracheal intubation and mechanical ventilation. Although, the institution of mechanical ventilation is considered life saving, the associated complications of tracheal stenosis, ventilator associated pneumonia, barotrauma , and neuromuscular weakness are not without considerable morbidity and mortality.
Non-invasive ventilation has demonstrated significant benefit in patients with hypercapnic respiratory failure from COPD, acute cardiogenic pulmonary edema, and hypoxemic respiratory failure in immunocompromised patients.
Despite the advantages of non-invasive ventilation via facemask, some patients fail because of mask intolerance and severity of disease. Further limitation to facemask non-invasive ventilation is that the seal integrity is lost when higher pressures are required. Unfortunately, certain types of respiratory failure such as that due to hypoxemia or shock may require such higher pressures.
In an attempt to improve patient tolerability and deliver higher pressures, a transparent helmet has been proposed as a novel interface for non-invasive ventilation. It encloses the entire head and neck of the patient. The design of the helmet confers some important advantages: 1) the transparency allows the patient to interact with the environment; 2) the lack of contact to the face lowers the risk of skin necrosis; 3) the helmet avoids problems of leaking with higher airway pressures that are seen with the face mask; 4) it can be applied to any patient regardless of facial contour.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01680783
|United States, Illinois|
|University of Chicago Medical Center|
|Chicago, Illinois, United States, 60637|
|Principal Investigator:||John P Kress, MD||University of Chicago|