Helmet ventilation and carbon dioxide rebreathing: Effects of adding a leak at the helmet ports

Abstract

Objective: We examined whether additional helmet flow obtained by a single-circuit and a modified plateau valve applied at the helmet expiratory port (open-circuit ventilators) improves CO2 wash-out by increasing helmet airflow. Design and setting: Randomized physiological study in a university research laboratory. Participants: Ten healthy volunteers. Interventions: Helmet continuous positive airway pressure and pressure support ventilation delivered by an ICU ventilator (closed-circuit ventilator) and two open-circuit ventilators equipped with a plateau valve placed either at the inspiratory or at the helmet expiratory port. Measurements and results: We measured helmet air leaks, breathing pattern, helmet minute ventilation (V̇Eh), minute ventilation washing the helmet (V̇Ewh), CO2 wash-out, and ventilator inspiratory assistance. Air leaks were small and similar in all conditions. Breathing pattern was similar among the different ventilators. Inspiratory and end-tidal CO2 were lower, while V̇Eh and V̇Ewh were higher only using open-circuit ventilators with the plateau valve placed at the helmet expiratory port. This occurred notwithstanding these ventilators delivered a lower inspiratory assistance. Conclusions: Additional helmet flow provided by open-circuit ventilators can lower helmet CO2 rebreathing. However, inspiratory pressure assistance significantly decreases using open-circuit ventilators, still casting doubts on the choice of the optimal helmet ventilation setup. © 2008 Springer-Verlag.