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Internal and emergency medicine
Mar 12, 2025;

Does helmet CPAP reduce carotid flow compared to oronasal mask CPAP? A randomized cross-over trial in healthy subjects.

Andrea Duca, Laura Frosio, Luca Molinero, Andrea Finazzi, Ivan Oppedisano, Carlo Bellazzi, Giovanni Nattino, Fabiola Signorini, Guido Bertolini, Eugenia Belotti, Roberto Cosentini
Author Information
  1. Andrea Duca: Agenzia Regionale Emergenza Urgenza, Milan, Italy. a.duca@areu.lombardia.it. ORCID
  2. Laura Frosio: ASST Papa Giovanni XXIII, Bergamo, Italy.
  3. Luca Molinero: ASST Papa Giovanni XXIII, Bergamo, Italy.
  4. Andrea Finazzi: ASST Papa Giovanni XXIII, Bergamo, Italy.
  5. Ivan Oppedisano: ASST Papa Giovanni XXIII, Bergamo, Italy.
  6. Carlo Bellazzi: ASST Papa Giovanni XXIII, Bergamo, Italy.
  7. Giovanni Nattino: Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
  8. Fabiola Signorini: Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
  9. Guido Bertolini: Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
  10. Eugenia Belotti: ASST Papa Giovanni XXIII, Bergamo, Italy.
  11. Roberto Cosentini: ASST Papa Giovanni XXIII, Bergamo, Italy.
PMID: 40072680 DOI: 10.1007/s11739-025-03914-6

Abstract

This study aimed to assess whether delivering Continuous Positive Airway Pressure (CPAP) through a Helmet interface (H-CPAP) reduces common carotid artery flow (CCAF), compared to breathing room air (RA) or using an oronasal mask (M-CPAP). This trial is an unblinded, randomized, controlled crossover trial. The primary outcome was CCAF, measured using Doppler ultrasound. The secondary outcome was mean arterial pressure (MAP). A convenient sample of adult healthy volunteers was enrolled. Subjects were enrolled and randomized to receive either H-CPAP or M-CPAP first at +���10 cmHO, followed by the alternate intervention, each for 5 min. CCAF, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO���), and anxiety score (AS) were recorded at baseline (RA) and after 5 min under each CPAP condition. Results showed a significant 14% reduction in CCAF between RA and H-CPAP (p���=���0.001) and a 13% reduction between M-CPAP and H-CPAP (p���=���0.004), with no significant difference between RA and M-CPAP. MAP remained unchanged across treatments, suggesting that the reduction in cerebral perfusion observed with H-CPAP was independent of systemic blood pressure changes. Helmet CPAP significantly reduces CCAF compared to RA and M-CPAP. While H-CPAP may offer advantages in respiratory support, its effect on cerebral perfusion suggests caution in patients with impaired cerebral autoregulation, such as those with stroke.

Keywords

Cerebrovascular circulation Helmet Masks Non-invasive ventilation Positive-pressure respiration

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Journal Article

Word Cloud

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