Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation – A Concise Review

Abstract

Non-invasive ventilation (NIV) has dramatically changed the treatment of both acute and chronic respiratory failure in the last 2 decades. The success of NIV is correlated to the application of the “best ingredients” of a patient’s “tailored recipe,” including the appropriate choice of the selected candidate, the ventilator setting, the interface, the expertise of the team, and the education of the caregiver. The choice of the interface is crucial for the success of NIV. Type (oral, nasal, nasal pillows, oronasal, hybrid mask, helmet), size, design, material and headgears may affect the patient’s comfort with respect to many aspects, such as air leaks, claustrophobia, skin erythema, eye irritation, skin breakdown, and facial deformity in children. Companies are paying great attention to mask development, in terms of shape, materials, comfort, and leak reduction. Although the continuous development of new products has increased the availability of interfaces and the chance to meet different requirements, in patients necessitating several daily hours of NIV, both in acute and in chronic home setting, the rotational use of different interfaces may remain an excellent strategy to decrease the risk of skin breakdown and to improve patient’s tolerance. The aim of the present review was to give the readers a background on mask technology and materials in order to enhance their “knowledge” in making the right choice for the interface to apply during NIV in the different clinical scenarios.

Comparative evaluation of three total full-face masks for delivering Non-Invasive Positive Pressure Ventilation (NPPV): a bench study

“…These results can be partially explained by considering the different shape and material of the DFFM compared to the other two masks. In particular, the softer material of the flange, created to increase patient comfort, causes an initial pressure dissipation during the mechanical pressurization, with a consequently longer Delay trinsp, ∆Ptrigger and PTP t, while, once the interface is well pressurized, the time to reach the preset level of iPS is faster with DFFM than with the other 2 masks [ 33 ].…”

Mask interfaces and devices for home noninvasive ventilation in children

“…"Adult" masks can be used or adapted to fit adequately. 11 Only a few "adult" masks exist with a very small size.…”

“…Moreover, they can increase the risk of developing or worsening upper airway obstruction due to mandibular retrusion. 11 They may be occasionally indicated in older children, as an alternative in case of an intercurrent illness with nasal obstruction or intolerance of the regular nasal mask in this time period. However, among other limitations, management of secretions or excessive salivation may hamper its usage.…”

Practical Guide to Management of Long-Term Noninvasive Ventilation for Adults With Chronic Neuromuscular Disease

“…More than 200 vented face masks are commercially available today in a vast array of configurations. 39,40 Philips, ResMed, ResMed, Fisher & Paykel, and Drive Devilbiss frequently update a full range of PAP face masks suitable for home NIV. SleepNet, Circadience, Airway Management, BleepSleep, and others make specialized facial interfaces that may be preferred by some people with challenging fit or comfort needs.…”

“…Skin surface discomfort, discoloration, inflammation, or frank skin ulceration are common, especially when higher inspiratory pressures are applied. 40,160 First check for excessive tightening of the headgear straps. A mask that must be tightened enough to deform underlying skin does not fit well and should be repositioned or replaced with a new or different mask.…”