The Total Face Mask Is More Comfortable than the Oronasal Mask in Noninvasive Ventilation but Is Not Associated with Improved Outcome

Abstract

Background: Noninvasive positive-pressure ventilation (NPPV) is commonly used to improve ventilation and oxygenation and avoid endotracheal intubation and mechanical ventilation. Although clinically indicated, most patients fail to use NPPV due to mask intolerance. A total face mask was designed to increase compliance, but whether this translates into better outcome (improvement in clinical and blood gas parameters and less intubation) is unknown. Objectives: We compared the evolution of the clinical parameters, blood gases, levels of ventilatory support and rate of endotracheal intubation using the total face mask or the traditional oronasal mask during NPPV. Methods: A total of 60 patients were randomized to use either mask during NPPV. The clinical and laboratory parameters, as well as the level of ventilatory support were recorded at different intervals in both groups for up to 6 h. In addition, the tolerance for each mask and the need for endotracheal intubation were compared. Results: Patients tolerated the total face mask significantly better (p = 0.0010) and used NPPV for a longer time (p = 0.0017) when compared with the oronasal mask. Just 1 patient switched to the total face mask because of intolerance. Although better tolerated, the rate of endotracheal intubation was similar in both groups (p = 0.4376), as was the clinical and laboratory evolution. Conclusions: The total face mask was more comfortable, allowing the patients to tolerate NPPV longer; however, these accomplishments did not translate into a better outcome. Due to its comfort, the total face mask should be available, at least as an option, in units where NPPVs are routinely applied.

Rescue Therapy by Switching to Total Face Mask After Failure of Face Mask-Delivered Noninvasive Ventilation in Do-Not-Intubate Patients in Acute Respiratory Failure*

“…Nevertheless, 23 (64%) out of 36 patients in whom FM-NIV failed to reverse ARF and, therefore, switched to total FM survived hospital discharge. Patients of the "FM failure" group, compared to those of the "FM success" group, required longer time of NIV during the first 48 hrs (40 [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] hrs vs. 22 [15][16][17][18][19][20][21][22][23][24][25][26][27][28] hrs; p < 0.001, respectively) and a longer stay in critical care setting (8 [5-0] days vs. 5 [3][4][5][6][7][8] days; p = 0.007, respectively), and needed higher inspiratory positive airway pressure levels (18 [16][17][18][19][20] …”

“…Three randomized studies have been conducted to compare the former model of total FM (Total Face, Respironics, Murrysville, PA) to conventional facial masks as the initial interface strategy for NIV in patients in ARF (32)(33)(34). Total face was found more comfortable only in patients with prolonged ARF (32,33), but its use was not associated with reduction in intubation rate or mortality (32,34). It is noteworthy that its ability to prevent facial pressure sores has never been tested, especially in patients for whom NIV had to be continued over long periods of time.…”

Noninvasive Ventilation for Acute Respiratory FailureDiscussion

“…In subjects with acute respiratory failure, Ozsancak et al 125 found that the oronasal mask and total face mask were perceived to be equally comfort- able and had similar application times. In another study of subjects with acute respiratory failure, Chacur et al 126 reported that the total face mask was more comfortable than the oronasal mask and suggested that the total face mask should be available as an option in units where NIV is routinely applied. In a normal volunteer study, Holanda et al 127 found that the total face mask avoided pain on the bridge of the nose and presented no air leaks around the eyes and mouth.…”

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.…”