Mid-face hypoplasia after long-term nasal ventilation

Villa, Maria Pia; Pagani, Jacopo; Ambrosio, Rosa; Ronchetti, R; Bernkopf, Edoardo

doi:10.1164/ajrccm.166.8.257c

Cited by 70 publications

(60 citation statements)

References 6 publications

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“…11 In addition, HFNC therapy is delivered via the nose in a similar way to standard oxygen therapy, potentially eliminating the mid-face hypoplasia seen in some children after prolonged use of CPAP. 12,13 To the best of our knowledge, this is the first report using HFNC at home for the treatment of OSA. Previously, McGinley et al have used a similar nasal cannula system with insufflation of warm humidified air to treat adults 14 and children 15 with OSA; however, this was a hospital-based sleep lab report.…”

Section: Discussionmentioning

confidence: 90%

High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children

Joseph

Goldberg

Shitrit

et al. 2015

Journal of Clinical Sleep Medicine

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Introduction: Over the last decade, high-fl ow nasal cannula (HFNC) therapy has become an increasingly important and popular mode of noninvasive respiratory support. HFNC facilitates delivery of humidifi ed and heated oxygen at a high fl ow rate and generates positive airway pressure. Methods: We present fi ve cases of children with OSA without adenotonsillar hypertrophy who were treated with HFNC. Results: We demonstrated a statistically signifi cant improvement in apnea-hypopnea index and nadir oxygen saturation in this small cohort. Conclusion:We present our successful experience of treating severe OSA with HFNC in the home setting. Further randomized controlled trials are needed to determine whether HFNC could be considered as an established alternative for CPAP in OSA in children Keywords: high-fl ow therapy, obstructive sleep apnea, home care, pediatrics Citation: Joseph L, Goldberg S, Shitrit M, Picard E. High-fl ow nasal cannula therapy for obstructive sleep apnea in children.

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Section: Discussionmentioning

confidence: 90%

High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children

Joseph

Goldberg

Shitrit

et al. 2015

Journal of Clinical Sleep Medicine

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“…Of note, all patients who required a third mask change belonged to the MF group, which may be explained by the difficulty in finding an appropriate mask for children with facial deformity. The long-term side effects of NPPV in children, such as facial flattening or maxillary retrusion, should not be underestimated [13][14][15][16]. A systematic close surveillance of the tolerance of the interface is thus mandatory in children treated with long-term NPPV.…”

Section: Discussionmentioning

confidence: 99%

Interfaces for long-term noninvasive positive pressure ventilation in children

et al. 2012

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“…The impact of facial features, craniofacial anomalies, and patient size (in relation to available masks) on skin damage/pressure ulcers has not been described, although mid-face hypoplasia as a result of long-term NIV therapy has been reported in pediatric patients. 26,27 This underlying etiology should be considered when selecting masks for NIV. We observed more frequent and more severe skin compromise than previous reports of 49% with mostly transient or persistent erythema 28 and 88% stage I pressure ulcers in neonates using masks.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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BACKGROUND: Pressure ulcers (stages III and IV) are serious safety events (ie, never events).Healthcare institutions are no longer reimbursed for costs to care for affected patients. Medical devices are the leading cause of pediatric pressure ulcers. Face masks for noninvasive ventilation were associated with a high percentage of pressure ulcers at our institution. METHODS: A prospective cohort study investigated factors contributing to pressure ulcer development in 50 subjects using face masks for noninvasive ventilation. Color imaging, 3-dimensional surface imaging, and skin hydration measurements were used to identify early skin compromise and evaluate 3 interventions to reduce trauma: (1) a silicone foam dressing, (2) a water/polyethylene oxide hydrogel dressing, and (3) a flexible cloth mask. A novel mask fit technique was used to examine the impact of fit on the potential for skin compromise. RESULTS: Fifty subjects age 10.4 ؎ 9.1 y participated with color images for 22, hydration for 34, and mask fit analysis for 16. Of these, 69% had diagnoses associated with craniofacial anomalies. Stage I pressure ulcers were the most common injury. Skin hydration difference was 317 ؎ 29 for sites with erythema versus 75 ؎ 28 for sites without erythema (P < .05) and smallest for the cloth mask (P < .05). Fit distance metrics differed for the nasal, oronasal, and face shield interfaces, with threshold distances being higher for the oronasal mask than the others (P < .05). Areas of high contact were associated with skin erythema and pressure ulcers. CONCLUSIONS: This fit method is currently being utilized to select best-fit masks from available options, to identify the potential areas of increased tissue pressure, and to prevent skin injuries and their complications. Improvement of mask fit is an important priority for improving respiratory outcomes. Strategies to maintain normal skin hydration are important for protecting tissue integrity.

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Mid-face hypoplasia after long-term nasal ventilation

Cited by 70 publications

References 6 publications

High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children

High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children

Interfaces for long-term noninvasive positive pressure ventilation in children

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

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