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Anesth Analg. 2009 Jul;109(1):164-7. doi: 10.1213/ane.0b013e3181a1f708. Epub 2009 May 13.

Helmet ventilation for acute respiratory failure and nasal skin breakdown in neuromuscular disorders.

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Dipartimento di discipline Medico-Chirurgiche, Sezione di Anestesiologia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista-Molinette, Corso Dogliotti 14, 10126 Torino, Italy.


Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients with neuromuscular diseases in acute respiratory failure. However, nasal ulcerations might occur when masks are used as an interface. Helmet ventilation is a possible option in this case. We describe two patients with acute respiratory failure due to Duchenne muscular dystrophy who developed nasal bridge skin necrosis during NIV. Helmet pressure support ventilation caused significant patient-ventilator asynchrony, leading to NIV intolerance. Thus, biphasic positive airway pressure delivered by helmet was applied, which improved gas exchange and patient-ventilator interaction, allowing successful NIV.

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