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

Abstract

The last 2 decades have seen a growing trend towards the use of noninvasive ventilation (NIV) therapy in the management of many conditions that cause acute respiratory failure. However, there is a serious side effect that results in using these devices; the development of facial skin pressure damage, specifically pressure ulcers. This skin damage has a considerable effect on patients’ quality of life, treatment adherence and patients’ comfort in addition to the therapy challenges of wound care. The aim of this clinical review is to discuss the different characteristics of NIV interfaces and to provide evidence based recommendations to facilitate the selection and application of such interfaces to reduce NIV interfaces related pressure ulcers.

Material and Technology: Back to the Future for the Choice of Interface for Non-Invasive Ventilation – A Concise Review

“…Tsu-boi et al [33] demonstrated that nasal intermittent positive pressure ventilation delivered with custom-fabricated nasal mask was more effective than nasal intermittent positive pressure ventilation applied with a commercially available mask due to the smaller dead space and the less amount of leaks. Custom-made interfaces were also associated with less skin breakdown [54,[60][61][62] as compared to commercial "ready-to-use" masks [50]. Custom masks have been employed for a long time, but now their use is limited almost exclusively to the paediatric setting [49].…”

Interfaces, Circuits and Humidifiers

“…Interfaces influence compliance, comfort, synchrony, and ventilators' performance ( 6 , 7 ). An ideal interface is lightweight, is stable, is non-traumatic, has minimal dead space, is durable, has low resistance to airflow, is available in several sizes, is easy to clean and disinfect, is connectable with any ventilator, is easy to take off in order to avoid aspiration if the ventilator crashes or the patient vomits, and is affordable ( 8 , 9 ).…”

“…Skin lesions are frequent adverse events associated with NIV masks ( 9 ). Since impermeable silicone polymers are the most frequently used contact materials, increased humidity can provoke skin maceration and, consequently, increased risk of cutaneous lesions ( 8 ).…”

“…Skin lesions may be further aggravated by poor nutrition and the loss of muscular mass, making neuromuscular patients more susceptible to this kind of complications ( 34 ). The humidification of NIV circuits may also contribute to skin lesions by increasing skin moisture ( 9 ).…”

“…A meta-analysis of 22 studies, three of them included pediatric patients, has shown that hydrocolloid dresses were significantly more effective in preventing PU than gauze or standard skin care ( 46 ). The use of these materials as soon as skin redness appears is advised ( 9 ). However, not all types of protective patches were shown to prevent skin injury.…”