{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:32:40Z","timestamp":1793410360238,"version":"4.5.0"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["Ricerca Corrente 2022"],"award-info":[{"award-number":["Ricerca Corrente 2022"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018386","name":"Societ\u00e0 Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva","doi-asserted-by":"publisher","award":["2017 MSD AWARD"],"award-info":[{"award-number":["2017 MSD AWARD"]}],"id":[{"id":"10.13039\/100018386","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["Ricerca Corrente 2022"],"award-info":[{"award-number":["Ricerca Corrente 2022"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003196","name":"Societ\u00e0 Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva","doi-asserted-by":"publisher","award":["2017 MSD AWARD"],"award-info":[{"award-number":["2017 MSD AWARD"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The respective effects of positive end-expiratory pressure (PEEP) and pressure support delivered through the helmet interface in patients with hypoxemia need to be better understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the respective effects of helmet pressure support (noninvasive ventilation [NIV]) and continuous positive airway pressure (CPAP) compared with high-flow nasal oxygen (HFNO) on effort to breathe, lung inflation, and gas exchange in patients with hypoxemia (PaO2\/Fi \u00a0O2\u2009\u2264\u2009200).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifteen patients underwent 1-hour phases (constant Fi \u00a0O2) of HFNO (60 L\/min), helmet NIV (PEEP\u2009=\u200914 cm H2O, pressure support\u2009=\u200912 cm H2O), and CPAP (PEEP\u2009=\u200914 cm H2O) in randomized sequence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Inspiratory esophageal (\u0394PES) and transpulmonary pressure (\u0394PL) swings were used as surrogates for inspiratory effort and lung distension, respectively. Tidal Volume (Vt) and end-expiratory lung volume were assessed with electrical impedance tomography. \u0394PES was lower during NIV versus CPAP and HFNO (median [interquartile range], 5 [3\u20139] cm H2O vs. 13 [10\u201319] cm H2O vs. 10 [8\u201313] cm H2O; P\u2009=\u20090.001 and P\u2009=\u20090.01). \u0394PL was not statistically different between treatments. PaO2\/Fi \u00a0O2 ratio was significantly higher during NIV and CPAP versus HFNO (166 [136\u2013215] and 175 [158\u2013281] vs. 120 [107\u2013149]; P\u2009=\u20090.002 and P\u2009=\u20090.001). NIV and CPAP similarly increased Vt versus HFNO (mean change, 70% [95% confidence interval (CI), 17\u2013122%], P\u2009=\u20090.02; 93% [95% CI, 30\u2013155%], P\u2009=\u20090.002) and end-expiratory lung volume (mean change, 198% [95% CI, 67\u2013330%], P\u2009=\u20090.001; 263% [95% CI, 121\u2013407%], P\u2009=\u20090.001), mostly due to increased aeration\/ventilation in dorsal lung regions. During HFNO, 14 of 15 patients had pendelluft involving &amp;gt;10% of Vt; pendelluft was mitigated by CPAP and further by NIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with HFNO, helmet NIV, but not CPAP, reduced \u0394PES. CPAP and NIV similarly increased oxygenation, end-expiratory lung volume, and Vt, without affecting \u0394PL. NIV, and to a lesser extent CPAP, mitigated pendelluft.<\/jats:p>\n                    <jats:p>Clinical trial registered with clinicaltrials.gov (NCT04241861).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202204-0629oc","type":"journal-article","created":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T14:12:22Z","timestamp":1668521542000},"page":"1310-1323","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":84,"title":["Respective Effects of Helmet Pressure Support, Continuous Positive Airway Pressure, and Nasal High-Flow in Hypoxemic Respiratory Failure: A Randomized Crossover Clinical Trial"],"prefix":"10.1093","volume":"207","author":[{"given":"Luca S.","family":"Menga","sequence":"first","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Delle Cese","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Ros\u00e0","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Cesarano","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Scarascia","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Michi","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele G.","family":"Biasucci","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersilia","family":"Ruggiero","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio M.","family":"Dell\u2019Anna","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore L.","family":"Cutuli","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eloisa S.","family":"Tanzarella","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Pintaudi","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"De Pascale","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Sandroni","sequence":"additional","affiliation":[{"name":"Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1828-9143","authenticated-orcid":false,"given":"Salvatore Maurizio","family":"Maggiore","sequence":"additional","affiliation":[{"name":"University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d\u2019Annunzio University of Chieti-Pescara, Chieti, Italy; and"},{"name":"Department of Anesthesiology, Critical Care Medicine and Emergency, SS. 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