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. 2022 Oct 14;12:94. doi: 10.1186/s13613-022-01069-7

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — Representative tracings of respiratory mechanics of a patient treated with helmet pressure support ventilation. Due to the high compliance of the interface, asynchronies are common during helmet NIV. Inspiratory and expiratory trigger delays are displayed, together with the slow increase and decay in airway pressure. Despite the short time of synchrony, the mean expiratory airway pressure is higher than the set PEEP (dotted lines in the Paw tracing) and the mean expiratory transpulmonary pressure is higher than the end-expiratory transpulmonary pressure (dotted lines in the PL tracing). Due to the significant trigger delays caused by interface compliance, inspiratory effort and ventilator assistance are (at least in part) out-of-phase, avoiding excessive dumps in transpulmonary pressure during inspiration. This de-synchronization may further enhance lung protection. Acronyms; PES, esophageal pressure; PL, transpulmonary pressure