Exhaled air dispersion during non-invasive ventilation via helmet masks

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Rationale: Application of non-invasive ventilation (NIV) via helmet masks is an option for managing infectious patients with severe respiratory failure before haemodynamic instability. However it is unknown whether there is any leakage of exhaled air during NIV application via helmet masks. Methods: We examined the exhaled air dispersion during application of NIV by a servo ventilator with double circuits and filters via different helmet masks on a high fidelity human patient simulator (HPS) in a negative pressure room with 12 air changes/hr. Exhaled air was marked by intrapulmonary smoke particles, illuminated by laser light sheet, and captured by a high definition video camera for data analysis. Results: During application of NIV via the SeaLong oxygen head tent with the HPS programmed in mild lung injury, exhaled air was noted to leak through the neckseal interface with a radial distance of 150 to 230mm when IPAP was increased from 12 to 20cmH20 respectively while keeping the EPAP at 10cmH20. During application of NIV via the StarMed CaStar R helmet mask with a tight air cushion around the neck interface, there was negligible air leakage. Conclusion: Helmet mask with a good neckseal is needed to prevent air leakage during application of NIV.

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