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

Abstract

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.

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

“…18 Use of an oronasal mask was a significant risk factor for tissue injury among subjects Ͼ18 y old. 39 Our results suggest that oronasal masks would be a risk factor in younger patients as well.…”

Nursing and Respiratory Collaboration Prevents BiPAP-Related Pressure Ulcers

“…Some of the risk factors for developing pressure ulcers found to be unique in children are prolonged intensive care stays (N 4 days), age less than 2 years old, and requirement of mechanical or noninvasive ventilation such as BiPAP, CPAP, HFOV, and ECMO (Schindler et al, 2011). In BiPAP-related pressure ulcers, the areas where the mask contacts the face, the nasal bridge and forehead, are the most common places where skin breakdown occurs (Yamaguti et al, 2014).…”

“…Although BiPAP has been shown to provide positive outcomes without the complications associated with endotracheal intubation, it is not without its own risks. The most common causes for NIV failure is mask discomfort and skin breakdown (Yamaguti et al, 2014). Success of BiPAP therapy is highly dependent on the patient's ability to tolerate the mask interface.…”

Ventilation non invasive en réanimation. Choix de l’interface

“…Survenant chez au moins 20 % des malades, sa proportion augmente rapidement avec la durée de ventilation [22]. Soixante-dix pour cent des patients ventilés avec un masque NB en développent au-delà de 12 heures de VNI [18].…”