Uso de parches protectores faciales no reduce la presión facial en un modelo simulado de ventilación mecánica no invasiva

Abstract

Background: Non-invasive mechanical ventilation (NIMV) frequently involves the development of pressure ulcer (PU) secondary to face-masks. Its prevention considers the empirical use of protective patches between skin and mask, in order to reduce the pressure exerted by face-masks. Objectives: To evaluate the effect of protective patches on the pressure exerted by face-masks, and its impact on ventilatory parameters. Method: A simulated model of BiPAP using total face mask on a training phantom with a physiological airway model (ALS PRO+) in supine position was used. The pressure on the front, chin and cheek was measured using 3 types of patches commonly used versus a control group, using pressure sensors (Interlinks Electronics(R)). The values obtained with the model of mask-protective patches in the programmed variables (peak inspiratory flow (PIF), expired tidal volume (Vte) and inspiratory positive pressure (IPAP)) were evaluated with a Trilogy 100 ventilator, Respironics(R). The programming and recording of the variables were carried out in 8 opportunities in each group by independent operators. Results: Any decrease in facial pressure with the protective patches used was observed, compared to the control group. Moltopren(R) increased facial pressure at all support points (p < 0.001), increased leakage, decreased PIF, Vte and IPAP (p < 0.001). Hydrocolloid patches increased facial pressure only in the left cheek, increased leakage and decreased PIF. Polyurethane patches did not produce changes in facial pressure or ventilatory variables. Conclusion: The use of Moltopren(R), hydrocolloid and transparent polyurethane protective patches did not contribute to the decrease on facial pressure. A deleterious effect of Moltopren and hydrocolloid patches was observed on the administration of ventilatory variables, concluding that the non-use of the protective patches allowed a better administration of the programmed parameters.

RETRACTED: Effect of hydrocolloid dressing on pressure ulcer in patients with non‐invasive positive pressure ventilation: A meta‐analysis

“…Skin contact and excessive pressure on NIPPV masks are the primary causes of facial pressure ulcers 32 . NIPPV masks must fit snugly on the face to maintain their ventilation function.…”

“…Skin contact and excessive pressure on NIPPV masks are the primary causes of facial pressure ulcers. 32 NIPPV masks must fit snugly on the face to maintain their ventilation function. However, this puts pressure on the skin tissue, especially on the nose and cheekbones.…”

Interfaces, Circuits and Humidifiers

“…In pediatric patients, the risk factors for PUs are skin immaturity, decreased/reduced mobility, altered neurological status, and the use of masks that are too small or do not fit to the facial anatomy of the child, as what happens in children with craniofacial anomalies (44,45).…”

“…However, not all types of protective patches were shown to prevent skin injury. Therefore, selection of the most suitable mask and headgear, fixation with an optimal tension, and frequent inspection for skin alterations represent key elements for effective PU prevention (45).…”

Non-invasive ventilation in amyotrophic lateral sclerosis

“…One study showed that facial pressure ulcers cannot be prevented by protective patches. 27 In patients with functioning mouth muscles, daytime mouthpiece ventilation may be beneficial due to the reduced risk of facial pressure ulcers as well as enhanced speech and swallowing. 28…”