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When we see the images of the wards where Covid-19 patients are hospitalized, we are sometimes struck by the image of a transparent helmet which is lowered on their head. People almost look like divers. It is a tool invented and produced in Italy, with the Italian resuscitation experts who have become “standard bearers” in the world of the use of this technology. Now this “made in Italy” path is confirmed as an opportunity for treatment capable of reduce the use of intubation.
This was reported by research that appeared in the prestigious scientific journal Jama, which demonstrates how this means for non-invasive respiratory support reduces the need for intubation by 40%, compared to high-flow oxygen therapy, which is considered the optimal respiratory support. in case of hypoxemia, that is, of oxygen deficiency in the blood.
This is how the lungs are “assisted”
The main reason for hospitalization in resuscitation of patients with Covid-19 is acute respiratory failure, caused by interstitial pneumonia caused by the Sars-CoV-2 virus and by the reactions it induces in the body. The HENIVOT study, coordinated by Domenico Luca Grieco and Massimo Antonelli (for the COVID-ICU Gemelli Study Group), indicates that the helmet could be the best way to ‘breathe’ these patients, reducing the need for intubation and invasive mechanical ventilation.
“The helmet is an all-Italian approach. Its use is not frequent abroad – explains Domenico Luca Grieco, resuscitator at the Intensive Care Unit of the 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).
Helmet’ it has been 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. 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 had shown that the use of these high pressures protects the lung from further damage during ventilation. Furthermore, the helmet is very comfortable compared to the other interfaces for non-invasive ventilation: this allows 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 avoids the use of invasive ventilation (intubation) in about 40% more patients. But patients treated with a helmet must be closely monitored, because when intubation becomes necessary, it should not be delayed, as doing so would increase mortality “.
The results are promising
What emerges from the Italian study will obviously be confirmed by research on a higher number of patients. But it is still an important indication. “The HENIVOT study, coordinated by us – recalls Massimo Antonelli, director of Anesthesia, Intensive Care, Intensive Care and Clinical Toxicology of the Agostino Gemelli IRCCS University Hospital Foundation and full professor of Anesthesiology and Intensive Care at the Catholic University, Rome campus – was funded by Italian Society of Anesthesia, Analgesia, Intensive Care and Intensive Care (SIAARTI) and conducted in collaboration with the Rimini Hospital and the Universities of Ferrara, Chieti and Bologna.
This research, like all the efforts made during the pandemic, is the result of the enormous team work of resuscitators, trainees, nurses and all the health personnel involved in the care of patients with Covid-19 in the intensive care of the Gemelli Hospital. and the other hospitals involved “.
The research examined 109 patients enrolled in the aforementioned Italian intensive care units and demonstrated that the helmet is the best performing system for assisting patients with acute respiratory failure due to Covid-19.
“This study supported by SIAARTI confirms that the national scientific society of anesthesiologists-resuscitators is active at the forefront in identifying new and better therapeutic pathways, and in the appropriate indication of devices – underlines Flavia Petrini, president of SIAARTI. The opportunity to have state-of-the-art healthcare technologies designed and developed in our country, but above all the ability of Italian researchers to identify how they should be managed and monitored: all this offers intensive care specialists important therapeutic weapons and confirms the our professional vocation to be protagonists in the development of new care paths and best practices for critically ill patients. Our hope in the face of the HENIVOT study is therefore that what is being tested today with such promising results within a still limited population of patients, if supported by even more robust evidence, may quickly become a new standard of care for the whole world of intensive care “.
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