Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

Abstract

Objective: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. Methods: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO 2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. Results: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO 2 entering the ventilator circuit was zero for the TFM. Conclusions: The shortterm adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO 2 from the circuit is less likely to occur when a TFM is used.Keywords: Intermittent positive-pressure ventilation; Masks/adverse effects; Respiratory insufficiency; Equipment failure analysis. ResumoObjetivo: Falhas da ventilação não-invasiva (VNI) têm sido relacionadas a efeitos adversos agudos do uso de máscaras. O objetivo deste estudo foi comparar a incidência, tipo e intensidade de eventos adversos e conforto das máscaras facial total (MFT), facial (MF) e nasal (MN). Métodos: Estudo randomizado, tipo cruzado, em 24 voluntá-rios sadios submetidos a seis períodos de VNI, modo bilevel positive airway pressure em ajustes de baixa e moderada a alta pressão. Foi aplicado um questionário de avaliação de onze eventos adversos especificamente relacionados ao uso das máscaras. O conforto foi avaliado por escala visual analógica. O CO 2 exalado no circuito foi medido entre a conexão da máscara e o orifício de exalação. Resultados: A MFT teve desempenho similar a MF e MN quanto a escores de conforto. A aplicação de pressões mais altas reduziu o conforto e aumentou a incidência e a intensidade dos eventos adversos, independentemente do tipo de máscara. A MFT teve melhor desempenho quanto a vazamentos e dor no nariz e pior resultado quanto ao ressecamento oronasal e claustrofobia. A MF teve o pior resultado quanto a vazamentos. A pressão parcial do CO 2 exalado no circuito permaneceu em zero com a MFT. Conclusões: Os eventos adversos agudos causados pelas interfaces de VNI são relacionados ao tipo de máscara e aos parâmetros de press...

Treatment-Related Risk Factors for Development of Skin Breakdown in Subjects With Acute Respiratory Failure Undergoing Noninvasive Ventilation or CPAP

“…NIV delivered via TFM has been proposed as an intervention to reverse ARF, and its use has been associated with better tolerance and comfort compared with an ONM. [33][34][35] These findings reinforce the importance of recommending the use of interfaces that generate less pressure against the face (ie, TFM or helmet) 36 for subjects who need prolonged NIV to prevent the development of SB, increasing the compliance and success of NIV. Furthermore, in patients who require prolonged intermittent mandatory ventilation, rotating the use of different types of masks may be another strategy for decreas- Hosmer-Lemeshow test ϭ chi-square ϭ 0.016.…”

Interfaces for noninvasive ventilation: does it matter?

“…The optimal interface for NIV has yet to be identified. Although studies of healthy volunteers provide important information, (6,7) how well their findings can be generalized to the population of patients in acute respiratory distress is unclear. Most studies, including the one presented by Holanda, et al, (6) employ a randomized, crossover design where each subject receives each interface studied in a random order, with an interval between each test to allow for washout of the effect from the previous test.…”

“…Although studies of healthy volunteers provide important information, (6,7) how well their findings can be generalized to the population of patients in acute respiratory distress is unclear. Most studies, including the one presented by Holanda, et al, (6) employ a randomized, crossover design where each subject receives each interface studied in a random order, with an interval between each test to allow for washout of the effect from the previous test. (6)(7)(8)(9) The advantage of this design is that the subjects act as their own controls, which has the potential to minimize confounding and also requires fewer subjects in total.…”

“…Most studies, including the one presented by Holanda, et al, (6) employ a randomized, crossover design where each subject receives each interface studied in a random order, with an interval between each test to allow for washout of the effect from the previous test. (6)(7)(8)(9) The advantage of this design is that the subjects act as their own controls, which has the potential to minimize confounding and also requires fewer subjects in total. The potential problem with this design is the assumption that, between study periods, there are no changes that would affect the outcomes studied.…”

“…(6) To that end, they conducted a well-designed randomized crossover study of 24 healthy subjects, testing six possible sequences involving the three different interfaces and two different pressure settings (for expiratory positive airway pressure-EPAP-and inspiratory positive airway pressure-IPAPlevels): low-pressure (EPAP of 6 cmH 2 O and IPAP of 11 cmH 2 O); and high-pressure (EPAP of 10 cmH 2 O and IPAP of 15 cmH 2 O). They also used a tool, which they had developed previously and adapted for use in this study, to assess short-term adverse effects.…”