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Helmet Ventilation for Acute Respiratory Failure and Nasal Skin Breakdown in Neuromuscular Disorders

Fabrizio Racca, MD^*, Lorenzo Appendini, MD, Giacomo Berta, MD^*, Luigi Barberis, MD^*, Ferdinando Vittone, MD^*, Cesare Gregoretti, MD, Gabriela Ferreyra, RT^*, Rosario Urbino, MD^*, and V. Marco Ranieri, MD^*

From the *Dipartimento di Anestesia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista-Molinette, Torino; Divisione di Pneumologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno (No); and Servizio di Anestesia e Rianimazione, Azienda Ospedaliera CTO-CRF-Maria Adelaide, Torino Italy.

Address correspondence and reprint requests to Fabrizio Racca, MD, Dipartimento di discipline Medico-Chirurgiche—Sezione di Anestesiologia e Rianimazione, Ospedale S. Giovanni Battista Corso Dogliotti 14, 10126 Torino. Address e-mail to fabrizio.racca{at}gmail.com.

Abstract

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 patientventilator interaction, allowing successful NIV.