Certain criteria are necessary to be able to successfully use helmet-based ventilation with patients.
The criteria for exclusion include:
Cardiopulmonary arrest
Glascow coma scale <8
Absence of airway protective gag reflex
Elevated intracranial pressure
Tracheostomy
Upper airway obstruction
Pregnancy
Patients who refuse to undergo endotracheal intubation, whatever the initial therapeutic approach
Patients who can benefit from helmet ventilation are those who have the following:
Hypoxemic failure due to cardiac pulmonary edema and non-cardiogenic acute hypoxemic respiratory failure (AHRF) and/or
Shock and/or
Ventilatory failure due to chronic obstructive pulmonary disease (COPD)/asthma
Additional inclusion criteria include:
Intact airway protective gag reflex
Able to follow instructions (e.g. squeeze hand on command, make eye contact with care provider, stick out tongue on command)
For patients who fail helmet ventilation and need to be intubated, the following predetermined criteria include:
Inability to achieve an arterial oxygen saturation by pulse oximetry or arterial blood gas ≥ 88%
Respiratory rate > 36 breaths/min
Loss of ability to maintain ventilation to keep arterial blood pH ≥ 7.20
Loss of protective airway gag reflex (seizure disorder, severe encephalopathy, Glascow Coma Scale <8)
Respiratory or cardiac arrest
Intolerance of the helmet or face mask
Development of airway bleeding, persistent vomiting and development of copious tracheal secretions
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