Reduced Air Leakage During Non-Invasive Ventilation Using a Simple Anesthetic Mask With 3D-Printed Adaptor in an Anthropometric Based Pediatric Head–Lung Model

Abstract

Non-invasive ventilation (NIV) is increasingly used in the support of acute respiratory failure in critically ill children admitted to the pediatric intensive care unit (PICU). One of the major challenges in pediatric NIV is finding an optimal fitting mask that limits air leakage, in particular for young children and those with specific facial features. Here, we describe the development of a pediatric head–lung model, based on 3D anthropometric data, to simulate pediatric NIV in a 1-year-old child, which can serve as a tool to investigate the effectiveness of NIV masks. Using this model, the primary aim of this study was to determine the extent of air leakage during NIV with our recently described simple anesthetic mask with a 3D-printed quick-release adaptor, as compared with a commercially available pediatric NIV mask. The simple anesthetic mask provided a better seal resulting in lower air leakage at various positive pressure levels as compared with the commercial mask. These data further support the use of the simple anesthetic mask as a reasonable alternative during pediatric NIV in the acute setting. Moreover, the pediatric head–lung model provides a promising tool to study the applicability and effectiveness of customized pediatric NIV masks in the future.

Current Advances and Gaps in Knowledge on Personalizing Masks for Noninvasive Respiratory Support

“…Increased patient discomfort and ventilation difficulties due to suboptimal fit of commercially available masks are well-recognized complications during non-invasive respiratory support throughout pediatric and adult respiratory care fields. [8][9][10][11][12][13]36 Strategies and new technologies that personalize masks may therefore provide a valuable solution for this current unmet medical need. While we indeed identified studies that address this challenge in adult chronic (home) respiratory support, limited research was conducted focusing on the acute setting for this age group.…”

“…An inadequate-fitting mask will frequently result in large air leaks and painful skin pressure points with ulcers and/or necrosis, leading to discomfort and patient-ventilator asynchrony, thereby contributing to treatment failure. 8,[10][11][12][13] For long-term treatment in the chronic setting, even small deficiencies in fitting and sizing may lead to discomfort over time, as mentioned by studies in adults receiving CPAP for obstructive sleep apnea. 9 Additionally, in children with home ventilation a frequent complication caused by increased pressure delivered to the face by ill-fitted masks is disruption of normal growth, leading to development of facial deformities.…”