{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:59:27Z","timestamp":1763535567644,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,11,20]],"date-time":"2018-11-20T00:00:00Z","timestamp":1542672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prolonged application time of helmet continuous positive airway pressure (CPAP) leads to better outcomes, but its timing can be influenced by the patient's tolerance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and objectives<\/jats:title><jats:p>To investigate patients' pain and tolerance experience related to different options of helmet fixing system: \u2018armpits strap\u2019 versus \u2018counterweights system\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This was a non\u2013randomized crossover study performed in a 10\u2010bed intensive care unit and referral extra corporeal membrane oxigenation (ECMO) centre of an Italian university hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty patients were enrolled. For helmet\u2010CPAP cycles performed with the armpit straps option, the mean pain numerical rate on a 0\u201310 scale was: 0\u00b75\u2009\u00b1\u20091\u00b74 at T<jats:sub>0<\/jats:sub> (baseline)<jats:sub>,<\/jats:sub> 1\u00b75\u2009\u00b1\u20092\u00b70 at T<jats:sub>1<\/jats:sub> (after 1\u00a0h) and 2\u00b76\u2009\u00b1\u20092\u00b75 at T<jats:sub>2<\/jats:sub> (end of cycle) (<jats:italic>p<\/jats:italic>\u2009=\u20090\u00b7023). The same analysis was performed for the counterweights fixing option. The mean score was 0\u00b73\u2009\u00b1\u20090\u00b76 at T<jats:sub>0<\/jats:sub>, 0\u00b73\u2009\u00b1\u20090\u00b72 at T<jats:sub>1<\/jats:sub> and 0\u00b75\u2009\u00b1\u20090\u00b77 at T<jats:sub>2<\/jats:sub> (<jats:italic>p<\/jats:italic>\u2009=\u20090\u00b7069). The mean duration for CPAP cycles performed with armpits strap and counterweights system was 3\u00b70\u2009\u00b1\u20091\u00b70 and 3\u00b79\u2009\u00b1\u20092\u00b73\u00a0h, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090\u00b7001). The mean section of the Basilic vein that was investigated before wearing the helmet was equal to 0\u00b723\u2009\u00b1\u20090\u00b720\u2009cm<jats:sup>2<\/jats:sup>. After 1 h of therapy with the counterweight option and armpit straps, the mean increase of the vein's section was 0\u00b727\u2009\u00b1\u20090\u00b721(<jats:italic>p<\/jats:italic>\u2009=\u20090\u00b7099) and 0\u00b730\u2009\u00b1\u20090\u00b725, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090\u00b7080).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The fixing system options in use to anchor the helmet during CPAP could worsen the pain experience level and cause device\u2010related pressure ulcers. When compared with the armpit straps option, the counterweights system appears to be a suitable approach to minimize the risks of pressure sores and pain during the treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to practice<\/jats:title><jats:p>The helmet CPAP is a reliable therapy to manage acute respiratory failure. Major improvements regarding pulmonary alveolar recruitment and oxygen levels are strictly related to a prolonged time of helmet CPAP cycles. Using a counterweight fixing system, where the armpits straps are not necessary, could be helpful in reducing patients' pain experience.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nicc.12399","type":"journal-article","created":{"date-parts":[[2018,11,21]],"date-time":"2018-11-21T02:17:00Z","timestamp":1542766620000},"page":"369-374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["How different helmet fixing options could affect patients' pain experience during helmet\u2010continuous positive airway pressure"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7475-277X","authenticated-orcid":false,"given":"Alberto","family":"Lucchini","sequence":"first","affiliation":[{"name":"General Intensive Care Unit, Emergency Department, ASST Monza\u00a0\u2013\u00a0San Gerardo Hospital, University of Milano\u2010Bicocca  Monza, MB Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Elli","sequence":"additional","affiliation":[{"name":"General Intensive Care Unit, Emergency Department, ASST Monza\u00a0\u2013\u00a0San Gerardo Hospital, University of Milano\u2010Bicocca  Monza, MB Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Bambi","sequence":"additional","affiliation":[{"name":"Emergency, ECMO and Trauma Intensive Care Unit, Azienda Ospedaliero Careggi University Hospital  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"De Felippis","sequence":"additional","affiliation":[{"name":"General Intensive Care Unit, Emergency Department, ASST Monza\u00a0\u2013\u00a0San Gerardo Hospital, University of Milano\u2010Bicocca  Monza, MB Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Vimercati","sequence":"additional","affiliation":[{"name":"General 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 Monza, MB Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Fumagalli","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, University Hospital of Milano\u2010Bicocca  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Foti","sequence":"additional","affiliation":[{"name":"General Intensive Care Unit, Emergency Department, ASST Monza\u00a0\u2013\u00a0San Gerardo Hospital, University of Milano\u2010Bicocca  Monza, MB Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,20]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"32","article-title":"Noninvasive ventilation: open issues for nursing research","volume":"88","author":"Bambi S","year":"2017","journal-title":"Acta Bio\u2010Medica de L'Ateneo 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