Resuscitators in slang call it a ‘helmet’ and it is a strange tool (it looks like a diver’s helmet) that allows patients with severe respiratory failure, such as those with Covid-19 pneumonia, to breathe. The helmet was invented and produced in Italy, and it is almost only Italian resuscitators who use it. But now, a study just published in the prestigious scientific journal JAMA, shows that the ‘Italian way’ to non-invasive respiratory support – the ‘helmet’ in fact – can be the winning one in patients with Covid-19 because it reduces the need for resort to intubation, as opposed to high-flow oxygen therapy, which is considered the optimal respiratory support in case of hypoxemia. The main reason for hospitalization in resuscitation of patients with Covid-19 is acute respiratory failure, caused by pneumonia. Domenico Luca Grieco and Massimo Antonelli (for the COVID-ICU Gemelli Study Group), authors of the work just published in JAMA suggest, through the results of the HENIVOT study, that the helmet could be the best way to make these patients ‘breathe’. reducing the need for intubation and invasive mechanical ventilation.
“The helmet is an all-Italian approach. Its use is not frequent abroad – said Dr. 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). The ‘helmet’ (or helmet) was 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 one very simple tool to use. The helmet – continued Dr. Grieco – is a different way of helping 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 have 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. These are promising results, the result of work conducted in an emergency context, and lead us to hypothesize that the use of a helmet, although it requires very experienced personnel and specific settings, can be considered in protected contexts and can improve the therapy of patients suffering from COVID-19 and, more generally, from hypoxemic respiratory failure “.
The publication on JAMA is accompanied by an editorial that actually opens the use of this method and identifies the novelty of the study. “The results of our study – concluded Dr. Grieco – will be confirmed by research on a higher number of patients. This is a ‘proof of concept’ study, far from conclusive, which however has made this purely Italian method of ventilation known to the world ”. “The HENIVOT study, coordinated by us – said Massimo Antonelli, director of Anesthesia, Reanimation, Intensive Care and Clinical Toxicology of the Agostino Gemelli IRCCS University Polyclinic Foundation and full professor of Anesthesiology and Reanimation at the Catholic University, Rome campus – was financed by the Italian Society of Anesthesia, Analgesia, Resuscitation 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 teamwork of resuscitators, trainees, nurses and all the health personnel involved in the care of patients with Covid-19 in the intensive care units of the Gemelli Hospital. and the other hospitals involved “.
The HENIVOT study was conducted between October 2020 and February 2021 on 109 patients enrolled in some Italian intensive care units and has shown that the helmet is the most performing system to assist patients with acute respiratory failure due to Covid-19. During the COVID-19 pandemic, Italian resuscitators were the first to adopt this type of ventilatory support, moreover all made in Italy, given that the helmets are produced in Mirandola, in the ‘Silicon Valley’ of the Italian electromedical sector; those used for this study in particular are produced by two companies, Dimar and Intersurgical. To believe in helmets for patients with Covid-19 were also 5 great Italian entrepreneurs (Flavio Cattaneo, Luca Cordero di Montezemolo, Diego Della Valle, Isabella Seragnoli and Alberto Vacchi) who, last spring, through the association ‘Aiutiamoci’, which they founded, they bought several hundred, to donate them to various Italian regions, including Lazio. Part of the ‘helmets’ used at the Columbus Covid2 Hospital-Gemelli arrived thanks to this act of generosity. And the resuscitators of the Columbus Covid2 Hospital-Gemini, with the study published in JAMA, have shown the world that the helmet can be the best way to assist these patients. A real ‘Italian way’ to respiratory support. And the resuscitators of the Columbus Covid2 Hospital-Gemini, with the study published in JAMA, have shown the world that the helmet can be the best way to assist these patients. A real ‘Italian way’ to respiratory support. And the resuscitators of the Columbus Covid2 Hospital-Gemini, with the study published in JAMA, have shown the world that the helmet can be the best way to assist these patients. A real ‘Italian way’ to respiratory support.
