Third question :: GIACOMO Grasselli. “What interface should we use ?” The goal of using NIV is offload Resp muscles. Most patients use mouth to breathe. 
Again bringing back the classic Greico ICM 2021 review article on NIV. Helmet - why does it tend to work ? May be asynchronic pressure swings providing asynchronous support. So “IS HELMET better tolerated “?
Only place I know that uses helmet ubiquitously is @BSUH_icu @katinthelair correct ?
Helmet is great but not without its disadvantages
Why is asynchronous support beneficial? Becuse it may reduce harm
Give helmet a try. 🤓
In summary , helmet seems to have some benefit. Helmet also makes v difficult to measure tidal volume for patient. There’s a lot we still don’t know about NIV. @DrLeoHeunks is it because helmet allow apply higher leaves of PEEP for longer and thus reducing respiratory effort ?
Ans : probably combination of higher levels of PEEP and longer periods of it. Next Q : if there are + ground glass changes in CT vs consolidation then generally may be helmet NIV is more beneficial. 🤔 but the KEY reminder : to offload Resp muscles and not to recruit more alveoli
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