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

José Vergara; Michael J Brenner; Stacey A Skoretz; Vinciya Pandian; Amy Freeman-Sanderson; Alessandra Dorça; Debra Suiter; Martin B Brodsky

doi:10.1177/17511437241231704

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

J Intensive Care Soc. 2024 Feb 29;25(3):326-332. doi: 10.1177/17511437241231704. eCollection 2024 Aug.

Authors

José Vergara¹, Michael J Brenner², Stacey A Skoretz^{3

4

5}, Vinciya Pandian⁶, Amy Freeman-Sanderson^{7

8

9

10}, Alessandra Dorça¹¹, Debra Suiter¹², Martin B Brodsky^{13

14

15}

Affiliations

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.

Keywords: COVID-19; NIV; Noninvasive ventilation; SARS-CoV-2; coronavirus; deglutition; dysphagia; helmet; voice.