Continuous positive airway pressure with modified helmet for treatment of hypoxemic acute respiratory failure in infants and a preschool population: A feasibility study

Objective: To analyze the feasibility of using continuous positive airway pressure (CPAP) delivered via a modified helmet to treat children with hypoxemic acute respiratory failure. Design: A single-center, prospective, clinical study. Setting. Pediatric intensive care unit in a university hospital. Patients: Fifteen consecutive children (from 1 month to 5 yrs of age) with hypoxemic acute respiratory failure (defined as Pao(2)/ FIO2 < 300). Interventions. CPAP was delivered via a modified helmet (CaStar, Starmed, Italy) of reduced size, fastened by a device we call a "baby-body." The feasibility of CPAP with the helmet was the primary end point. The improvement of gas exchange was the secondary one. Measurements and Main Results. Ten of 15 children had multiple organ failure. Nine of 15 children were <= 1 yr old. The helmet was well tolerated by all the children. Additional sedation was provided to four patients. No children developed significant complications (skin lesion, gastric distension, conjunctivitis, epistaxis, or loss of invasive devices) or lethal, helmet-related events. Oxygenation improved above baseline after 2 hrs of CPAP with the helmet; no significant variation of hemodynamic variables was detected. Conclusions. The helmet is a suitable device for delivery of CPAP to infants and preschool children with hypoxemic acute respiratory failure. It was well tolerated and improved oxygenation.