Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2020; 8(10): 1939-1943
Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1939
Helmet-based noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: A case report
Mi Hwa Park, Min Jeong Kim, Ah Jin Kim, Man-Jong Lee, Jung-Soo Kim
Mi Hwa Park, Min Jeong Kim, Jung-Soo Kim, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Incheon 22332, South Korea
Ah Jin Kim, Man-Jong Lee, Division of Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Incheon 22332, South Korea
Author contributions: Park MH, Kim JS were responsible for the data analysis and interpretation and contributed to writing the manuscript; Kim MJ, Lee MJ, Kim AJ were responsible for the data selection and clinical interpretation of the data; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent to publish case details and any accompanying images was obtained from the patient.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jung-Soo Kim, MD, Professor, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, 27 Inhang Road, Jung-gu, Incheon 22332, South Korea. acecloer31@gmail.com
Received: February 8, 2020
Peer-review started: February 8, 2020
First decision: March 18, 2020
Revised: April 4, 2020
Accepted: April 30, 2020
Article in press: April 30, 2020
Published online: May 26, 2020
Processing time: 107 Days and 7.8 Hours
Abstract
BACKGROUND

Noninvasive ventilation (NIV) reduces intubation rates, mortalities, and lengths of hospital and intensive care unit stays in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Helmet-based NIV is better tolerated than oronasal mask-based ventilation, and thus, allows NIV to be conducted for prolonged periods at higher pressures with minimal air leaks.

CASE SUMMARY

A 73-year-old man with a previous diagnosis of COPD stage 4 was admitted to our medical intensive care unit with chief complaints of cough, sputum, and dyspnea of several days’ duration. For 10 mo, he had been on oxygen at home by day and had used an oronasal mask-based NIV at night. At intensive care unit admission, he breathed using respiratory accessory muscles. Hypercapnia and signs of infection were detected, and infiltration was observed in the right lower lung field by chest radiography. Thus, we diagnosed AECOPD by community-acquired pneumonia. After admission, respiratory distress steadily deteriorated and invasive mechanical ventilation became necessary. However, the patient refused this option, and thus, we selected helmet-based NIV as a salvage treatment. After 3 d of helmet-based NIV, his consciousness level and hypercapnia recovered to his pre-hospitalization level.

CONCLUSION

Helmet-based NIV could be considered as a salvage treatment when AECOPD patients refuse invasive mechanical ventilation and oronasal mask-based NIV is ineffective.

Keywords: Acute exacerbation of chronic obstructive pulmonary disease; Noninvasive ventilation; Helmet; Case report

Core tip: We present a case of acute exacerbation of chronic obstructive pulmonary disease in a 73-year-old male. Despite oronasal mask-based noninvasive ventilation (NIV) and adjustment of positive end-expiratory pressure and inspiratory positive pressures, hypercapnia and conscious level were not improved. The patient refused invasive mechanical ventilation, and accordingly we opted for helmet-based NIV. Subsequently, hypercapnia and conscious level recovered to his pre-hospitalization level. Helmet-based NIV may be considered as a salvage treatment, when an acute exacerbation of chronic obstructive pulmonary disease patient refuses invasive mechanical ventilation and has failed to respond to oronasal mask-based NIV.