key: cord-0867151-jxn2o8z4
authors: Mazza, Mariano; Di Costanzo, Domenica; Antonio M. Esquinas
title: Continuous positive airway pressure helmet in patients with ARDS due to COVID-19 pneumonia. Insights about a therapy monitoring protocol
date: 2022-03-18
journal: Aust Crit Care
DOI: 10.1016/j.aucc.2022.03.006
sha: bd1c4d5d84f75428d66ef5249b8e6195a29451c2
doc_id: 867151
cord_uid: jxn2o8z4

nan

To editor:

We have read with great interest the study by Privitera D et al. [1] , about the use of helmet -continuous positive airway pressure (CPAP) in patients with respiratory failure due to COVID-19 pneumonia. This study is clear in its structure, but we consider that some aspects should be clarified.

First, breathing pattern and respiratory rate (RR) seem to be the key guiding element for the adjustment and decision making along with oxygen saturation [2, 3] . However, in our opinion, there are other factors that could interfere with RR (fever, anxiety, discomfort, or pain). It is obviously a very sensitive factor, but not very specific, especially in emergency department setting [3] .

Authors did not analyzed patients' compliance and comfort towards Helmet interface, and though has been said that eleven patients (21,1% of the total) received morphine, the reason is not explained.

Then, the subgroup of helmet failure population, and causes of Helmet -failure as an interface are not well defined.

On this line, these two aspects could be key remarks for a proper helmet interface evaluation [4] , and could provide prevention tools from failure.

Nursing evaluation during treatment with helmet continuous positive airway pressure in patients with respiratory failure due to COVID-19 pneumonia: A case series

Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia

The determinants of respiratory rate during mechanical ventilation

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Secondly, at the time of this study, little data on thromboembolic complications from COVID-19 and use of low molecular weight heparin were already available in literature. We wondered if this therapy was used by the authors at that time and their results [5] .This study confirms the excellent results observed with this type of interface in patients with COVID-19, when a strict protocol of use is applied, highlighting the benefits of a correct monitoring.