Pressure Ulcer Incidence in Patients Wearing Nasal-Oral Versus Full-Face Noninvasive Ventilation Masks

Abstract

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Explain the importance of checking for pressure ulcers. 2. Identify areas of high risk for skin breakdown. 3. Enumerate advantages of wearing a full-face mask.To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue. " No CE test fee for AACN members.Background Device-related pressure ulcers from noninvasive ventilation masks alter skin integrity and cause patients discomfort. Objective To examine the incidence, location, and stage of pressure ulcers and patients' comfort with a nasal-oral mask compared with a full-face mask. Methods A before-after study of a convenience sample of patients with noninvasive ventilation orders in 5 intensive care units was conducted. Two groups of 100 patients each received either the nasal-oral mask or the full-face mask. Skin was assessed before the mask was applied and every 12 hours after that or upon mask removal. Comfort levels were assessed every 12 hours on a Likert scale of 1 to 5 (1, most comfortable). Results A pressure ulcer developed in 20% of patients in the nasal-oral mask group and 2% of patients in the full-face mask group (P < .001). Comfort scores were significantly lower (more comfortable) with the full-face mask (mean [SD], 1.9 [1.1]) than with the nasal-oral mask (mean [SD], 2.7 [1.2], P < .001). Neither mean hours worn nor percentage adherence differed significantly: 28.9 (SD, 27.2) hours and 92% for full-face mask and 25 (SD, 20.7) and 92% for nasal-oral mask. No patients who had a pressure ulcer develop with the nasal-oral mask had a pressure ulcer develop with the full-face mask. Conclusion The full-face mask resulted in significantly fewer pressure ulcers and was more comfortable for patients. The full-face mask is a reasonable alternative to traditional nasal-oral masks for patients receiving noninvasive ventilation. (American Journal of Critical Care. 2015;24:349-357) 1 The goal of noninvasive ventilation is to relieve symptoms associated with hypoventilation, exacerbation of chronic obstructive pulmonary disease, or impending respiratory failure; enhance gas exchange; maximize patients' comfort; and avoid intubation and invasive ventilation.1,2 Use of noninvasive ventilation is associated with device-related development of pressure ulcers under the mask. Published rates for the incidence of facial pressure ulcers associated with noninvasive ventilation masks range from 10% to 31%.3-5 Identification of device-related pressure ulcers, such as those associated with noninvasive ventilation masks, is becoming more common. [6][7][8] No research related to interventions to reduce the incidence or severity of pressure ulcers associated with noninvasive ventilation was found. However, several non-research-based recommendations were found in the literature. The Minnesota Hospital Association and recently the National Pressure Ulcer Advisory Panel (NPUAP) recommended consideration o...

Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies

“…However, patient discomfort and complications might limit continuous application of NIV [7], further decrease its efficacy, and even increase mortality. Some of these complications and discomfort were related to the mask [7–9, 38]. In order to improve tolerability for patients, a transparent helmet made from latex-free polyvinyl chloride was developed [13].…”

Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers

“…Skin assessment should begin at the areas that directly contact the mask, and those areas should be reassessed at least once per shift 35. However, Bambi et al,33 argued that skin assessment should be performed every 2 to 4 hours because clinical studies showed that pressure ulcers can develop in 4 to 6 hours under a continuous load.…”

“…The maximum time for continuous NIV is 11 hours. After that time, it is recommended to remove the interface and allow the skin to rest for at least 4 hours 35,40…”

“…The third study in this review was conducted by Schallom et al35 in 5 ICUs and investigated pressure ulcer incidence, location, and level of comfort of oronasal mask use compared to a TFM. A total of 200 patients were equally divided into 2 groups, and each group received a different type of mask.…”

Uso de parches protectores faciales no reduce la presión facial en un modelo simulado de ventilación mecánica no invasiva

“…Currently, measures to prevent PU consider the use of suitable masks, with strong evidence for the use of the total face mask model, as well as periodical revision of the skin and the placement of facial patches between the skin and the mask in risky areas 10,[16][17][18] . The protective patches are intended to create a physical barrier between the mask and the skin, in order to theoretically attenuate the pressure exerted on the skin, in an effect that we could call "meniscus effect", given the functional similarity achieved by the cartilaginous (meniscus) joint in the knee 19 .…”