Comparison of two humidification systems for long-term noninvasive mechanical ventilation

Nava, Stefano; Cirio, Serena; Fanfulla, Francesco; Carlucci, Annalisa; Navarra, Alessio; Negri, Alberto; Ceriana, Piero

doi:10.1183/09031936.00000208

Cited by 53 publications

(48 citation statements)

References 20 publications

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“…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.…”

Section: Discussionsupporting

confidence: 59%

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

et al. 2014

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BACKGROUND: Noninvasive ventilation (NIV) has been recognized as an effective strategy in preventing endotracheal intubation in subjects with acute respiratory failure (ARF). Some interface-related complications have also been recognized, such as skin breakdown (SB). The aim of this study was to determine the frequency of SB and identify potential treatment-related risk factors for its development in adults with ARF undergoing NIV or CPAP. METHODS: A cross-sectional study was conducted in a general hospital. Subjects were retrospectively enrolled in this study if they were > 18 y old and developed ARF caused by any condition in which NIV or CPAP was indicated for at least one application for a period longer than 2 h. The outcomes were the prevalence of SB and the evaluation of related risk factors. Data were extracted from the electronic medical records. A stepwise forward logistic regression model was used to identify independent risk factors for SB development. RESULTS: A total of 375 subjects (160 males) met the inclusion criteria and were enrolled in the study. Fifty-four subjects (14.4%) developed SB. The mean number of applications of NIV or CPAP carried out for > 2 h was higher in subjects with SB (7.1 ؎ 13.3 h) than in those without SB (4.4 ؎ 13.3 h) (P ‫؍‬ .03). Subjects with SB also presented a higher total duration of NIV use (44.6 ؎ 118.5 h) compared with subjects without SB (21.8 ؎ 45.5 h) (P ‫؍‬ .01). Subjects who developed SB presented a higher use of oronasal mask (92.6%) compared with the group that did not (21.5%) (P < .001). CONCLUSIONS: In patients with ARF undergoing NIV or CPAP, oronasal mask use for > 26 h was independently associated with development of SB.

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Section: Discussionsupporting

confidence: 59%

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

et al. 2014

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“…Clinically, strategies to minimize skin damage include alternating interface types/ designs, using proper fit techniques, reducing mask tightness, and applying spacers on the forehead to reduce pressure on the nose. [36][37][38] Subjects with facial deformities were more difficult to fit, and subjects Յ2-y-old used a custom mask due to the unavailability of acceptable commercial devices. 18 Use of an oronasal mask was a significant risk factor for tissue injury among subjects Ͼ18 y old.…”

Section: Discussionmentioning

confidence: 99%

Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers

et al. 2015

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BACKGROUND: Pressure ulcers (stages III and IV) are serious safety events (ie, never events).Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. METHODS: A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. RESULTS: Fifty subjects age 10.4 ؎ 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ؎ 29 for sites with erythema versus 75 ؎ 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers. CONCLUSIONS: This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity.

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“…These leaks are extremely common in neuromuscular patients. 19,20 Therefore, although an HME and a heated humidifier showed similar tolerance and side effects during long-term MV, 21 we prefer a heated humidifier because of its greater efficacy in case of unintentional leak. [22][23][24] In addition, as compared to a heated humidifier, an HME increases the resistance of the circuit and the dead space, and therefore the work of breathing, during invasive MV.…”

Section: Evaluation Of the Patients' Equipment Versus The Prescribersmentioning

confidence: 99%

“…However, despite their advantage of a minimal facial contact, which widens the field of vision and allows the use of eyeglasses, few patients used nasal pillows. 17 Until recently, all nasal pillows available in France had intentional leak and therefore could be used only with bi-level ventilators, given that any modification of a medical device (eg, sealing a hole) was prohibited by French law. We encourage manufacturers to develop non-leak nasal pillows, which may be an alternative to mouthpiece MV during daytime.…”

Section: Evaluation Of the Patients' Equipment Versus The Prescribersmentioning

confidence: 99%

Long-Term Mechanical Ventilation Equipment for Neuromuscular Patients: Meeting the Expectations of Patients and Prescribers

Lofaso¹,

Prigent²,

Tiffreau³

et al. 2013

Respir Care

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BACKGROUND:To maximize the likelihood of successful long-term mechanical ventilation (MV) in patients with neuromuscular diseases, ventilator characteristics and settings must be chosen carefully, taking into account both medical requisites and the patient's preference and comfort. OBJECTIVES: To evaluate patients' knowledge about and comfort with their long-term MV; to compare patients' and prescribers' opinions and expectations regarding long-term MV; and to compare the equipment used by the patients to the prescribers' current MV prescription. METHODS: Neuromuscular patients receiving long-term MV, and home MV prescribers in Belgium and France were asked to respond to a questionnaire survey specifically developed for the study. RESULTS: Completed questionnaires were collected from 209 patients (mean age 35.4 ؎ 15.9 y, range 3-86 y), ventilated since 11 ؎ 17 year, and 45 MV prescribers. One hundred sixty-three (78%) patients correctly designated their MV mode as a volume or pressure controlled mode. When an inspiratory trigger was available, 92% of the patients were able to use it, but only 69% were satisfied. Prescribers were more prone than patients to use new technologies such as an emergency-release system for the noninvasive interface (1-10 visual analog scale score 9.2 ؎ 1.5 vs 6.8 ؎ 3.3, P < .001), a humidification system (8.6 ؎ 1.4 vs 7.8 ؎ 2.6, P ‫؍‬ .02), a contactor for providing larger inspiratory volumes (8.4 ؎ 1.7 vs 6.0 ؎ 3.0, P ‫؍‬ .009), a built-in cough assistance mode (9.2 ؎ 1.4 vs 5.5 ؎ 3.5, P < .001), new options to improve speech, or new MV modes such as a volume-targeted pressure control. CONCLUSIONS: The opinions of patients and prescribers differed about the ideal home ventilator. Patients were less prone to use new technologies, mainly because of a lack of information, underlining the need for regular MV update in patients receiving long-term MV.

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Comparison of two humidification systems for long-term noninvasive mechanical ventilation

Cited by 53 publications

References 20 publications

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

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

Face Masks for Noninvasive Ventilation: Fit, Excess Skin Hydration, and Pressure Ulcers

Long-Term Mechanical Ventilation Equipment for Neuromuscular Patients: Meeting the Expectations of Patients and Prescribers

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