Swallowing during provision of helmet ventilation: Review and provisional multidisciplinary guidance

Author:

Vergara José1ORCID,Brenner Michael J2,Skoretz Stacey A345,Pandian Vinciya6,Freeman-Sanderson Amy78910,Dorça Alessandra11,Suiter Debra12,Brodsky Martin B131415

Affiliation:

1. Department of Surgery, University of Campinas, Campinas, SP, Brazil

2. Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA

3. School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

4. Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada

5. Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, BC, Canada

6. Department of Nursing Faculty, Johns Hopkins University, Baltimore, MD, USA

7. Graduate School of Health, University of Technology Sydney, NSW, Australia

8. Royal Prince Alfred Hospital, Sydney, NSW, Australia

9. Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia

10. Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Australia

11. Department of Health Sciences, Federal University of Goiás, Goiânia, Brazil

12. Department of Communication Sciences and Disorders, University of Kentucky, Lexington, USA

13. Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA

14. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA

15. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

Abstract

Use of noninvasive ventilation provided by a helmet increased globally during and after the COVID-19 pandemic. This approach may reduce need for intubation and its associated clinical complications in critically ill patients. Use of helmet interface minimizes virus aerosolization while enabling verbal communication, oral feeding and coughing/expectoration of secretions during its administration. Although improved oral hydration is a recognized benefit of helmet NIV, relatively little is known about the safety and efficiency of swallowing during helmet NIV. Risk of aspiration is a key consideration given the fragile pulmonary status of critically ill patients requiring respiratory support, and therefore the decision to initiate oral intake is best made based on multidisciplinary input. We reviewed the current published evidence on NIV and its effects on upper airway physiology and swallowing function. We then presented a case example demonstrating preservation of swallowing performance with helmet NIV. Last, we offer provisional multidisciplinary guidance for clinical practice, and provide directions for future research.

Publisher

SAGE Publications

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