Adaptation to different noninvasive ventilation masks in critically ill patients

Abstract

OBJECTIVE: To identify which noninvasive ventilation (NIV) masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. METHODS: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. RESULTS: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%). Total face masks were the most commonly used (in 74.7%), followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively). Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. CONCLUSIONS: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.

Facial pressure ulcers in inpatients undergoing non-invasive ventilation in intermediate care units

“…NIV routine usually depends on its objective, based on medical indication and the patient's clinical status. In this study, as in the study by Silva et al (2013), we found that participants sometimes had a very reserved prognosis, which made it impossible to remove NIV for facial rest, namely for feeding, oral hygiene, expectoration, and secretion aspiration. In relation to the time of NIV in days, we observed an increase of facial PUs after the fourth day.…”

“…In addition, in the study of Silva et al (2013) on the adaptation to different NIV interfaces in critically ill patients, 71.3% of the patients who needed NIV had RF, since acute RF leads to a severe deterioration of gas exchange (Silva et al, 2013). As mentioned above, ICU inpatients usually have a high risk of developing PUs.…”

“…NIV also maintains the ability to speak and cough, reduces the need for sedation, the risk of hemodynamic instability, and delirium, preserves the activity of respiratory muscles, and leads to less time on mechanical ventilation, ICU stay, and increased survival (Marcelino, 2009;Cruz & Zamora, 2013). However, it has been shown that one of the most common complications during this ventilation method is the ulceration of the nasal dorsum (Maruccia et al, 2015;Silva et al, 2013). The National Pressure Ulcer Advisory Panel (NPUAP) defines pressure ulcer as a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear, associated with a number of factors yet to be elucidated (National Pressure Ulcer Advisory Panel [NPUAP], 2015).…”

Short-term usage of three non-invasive ventilation interfaces causes progressive discomfort in healthy adults

“…Patient discomfort with the mask may result in early discontinuation (Pisani et al 2012 ; Silva et al 2013 ), and patients should try different types of interfaces to choose the most comfortable (BaHammam et al 2018 ). There is an agreement that comfort, in general, has a subjective nature, is influenced by different factors (physical, physiological, psychological), and is a reaction to the environment (De Looze et al 2003 ).…”

“…Lastly, we did not ask subjects to report what was the cause of their discomfort. While some causes of discomfort may be solved in a clinical setting (Silva et al 2013 ), presence of some adverse effects and subjective assessment of discomfort may not agree (Holanda et al 2009 ).…”