Nasal trauma due to continuous positive airway pressure in neonates

Fischer, Cyril; Bertelle, Valérie; Hohlfeld, Judith; Forcada-Guex, Margot; Stadelmann-Diaw, C.; Tolsa, Jean-François

doi:10.1136/adc.2009.179416

Cited by 173 publications

(183 citation statements)

References 21 publications

(28 reference statements)

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“…We observed more frequent and more severe skin compromise than previous reports of 49% with mostly transient or persistent erythema 28 and 88% stage I pressure ulcers in neonates using masks. 29 Our larger skin hydration differences were associated with visible erythema, as reported by others. 30 Hydration was greater for erythema than normal skin and higher for stage I pressure ulcers than erythema.…”

Section: Discussionsupporting

confidence: 68%

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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Section: Discussionsupporting

confidence: 68%

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

et al. 2015

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“…Nasal injuries were evaluated according to the classification proposed by Buettiker et al, [11] who described the severity of nasal trauma secondary to nCPAP in neonates. Nasal injuries were classifi ed as mild, moderate, and severe.…”

Section: Methodsmentioning

confidence: 99%

“…[6] Yong et al [10] reported an incidence of 35% for nasal trauma in the prongs group. Fischer et al [11] found that 420 (42.5%) of 989 patients developed a nasal trauma. Gunlemez et al [12] demonstrated that the silicon gel on the surface of the nostrils reduced the incidence of nasal injury in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants

Xie

2014

World Journal of Emergency Medicine

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“…49,50 Five studies involving 857 infants 21,29,33,38,40 revealed the incidence of nasal trauma in infants supported on HHHFNC compared with other forms of NIV. One more trial 26 revealed nasal trauma, but as scores rather than events, and could not be included in the analysis.…”

Section: Nasal Traumamentioning

confidence: 99%

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVE: High-flow therapy is the most recent, and popular, mode of respiratory support in neonates. However, the evidence supporting its efficacy and safety has not yet been established. We conducted a systematic review and meta-analysis of clinical trials comparing efficacy and safety of high-flow therapy compared with other modes of noninvasive ventilation (NIV) in preterm infants.METHODS: Articles were indexed by using Medline, Embase, Scopus, OpenSIGLE, Health Management Information Consortium, and Cochrane Central Register of Controlled Trials. Randomized or quasirandomized clinical trials involving preterm infants, comparing high-flow therapy with other modes of NIV, and reporting extractable data on relevant outcomes, were selected. Data on efficacy, safety, and other common neonatal outcomes were extracted on predesigned forms. RESULTS:In this analysis, we included 1112 preterm infants, participating in 9 clinical trials. High-flow therapy was similar in efficacy to other modes of NIV in preterm infants when used as primary support (odds ratio of failure of therapy, 1.02 [95% confidence interval: 0.55 to 1.88]), as well as after extubation (1.09 [0.58 to 2.02]). There were no significant differences in odds of death (0.48 [0.18 to 1.24]) between the groups. Preterm infants supported on highflow had significantly lower odds of nasal trauma (0.13 [0.02 to 0.69]).CONCLUSIONS: High-flow therapy appears to be similar in efficacy and safety to other conventional modes of NIV in preterm infants. It is associated with significantly lower odds of nasal trauma. Caution needs to be exercised in extreme preterm infants because of the paucity of published data.

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Nasal trauma due to continuous positive airway pressure in neonates

Cited by 173 publications

References 21 publications

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

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

Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants

Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis

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