Objective: To report the feasibility of helmet use in infants between 1 and 12 months old with acute respiratory failure.
Design and setting: Observations were made before and 2 h after helmet CPAP of 6 cm H(2)O. Failure was defined as recourse to intratracheal ventilation. Patient stabilization or improvement was defined as a variation <10% or a decrease >10% in one of the following: respiratory rate, inspired oxygen fraction, or capillary partial pressure of CO(2). Tolerance was assessed by the pain and discomfort score, the systematic search for pressure sores, and the measurement of helmet humidity and noise level.
Results: Twenty-three infants with a median age of 5 (2-8) months were included. Helmet CPAP failed in two (9%) patients. Stability or improvement occurred in 16 (70%) patients. The pain and discomfort score was stable or improved in 22 (96%). Pressure sores were found in three (13%) infants. Humidity was 98% (98-99%) and fell to 40% (39-43%) after the humidifier was stopped. The noise level in the helmet was 81 (77-94) dB-SPL.
Conclusions: The helmet was a satisfactory interface for CPAP delivery in young infants in more than two-thirds of the cases. Pressure sores can be prevented by placing a cushion in the helmet. Caregivers need to take into account the high humidity and noise levels of this interface.