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Pierucci P, Portacci A, Carpagnano GE, Banfi P, Crimi C, Misseri G, Gregoretti C. The right interface for the right patient in noninvasive ventilation: a systematic review. Expert Rev Respir Med 2022; 16:931-944. [PMID: 36093799 DOI: 10.1080/17476348.2022.2121706] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. AREAS COVERED This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. EXPERT OPINION The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.
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Affiliation(s)
- Paola Pierucci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milano,Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy and Fondazione Istituto "G.Giglio" Cefalù', Palermo, Italy
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Xavier JLDA, Madeiro Leite Viana Weaver F, Pinheiro GL, Sousa Fernandes PH, Genta PR, Lorenzi-Filho G. Patients with OSA on Oronasal CPAP Breathe Predominantly Through the Nose During Natural Sleep. Am J Respir Crit Care Med 2021; 205:250-252. [PMID: 34784495 DOI: 10.1164/rccm.202106-1502le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jeane Lima de Andrade Xavier
- Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division, São Paulo, Brazil
| | | | - George Lago Pinheiro
- Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division, São Paulo, Brazil
| | - Paulo Henrique Sousa Fernandes
- USP, 28133, Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division São Paulo, Sao Paulo, Brazil
| | - Pedro R Genta
- Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Universidade de Sao Paulo, 28133, Heart Institute (InCor), LIM 63, Hospital das Clínicas, HCFMUSP, Pulmonary Division, Faculdade de Medicina, FMUSP, Sao Paulo, Brazil;
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Abstract
BACKGROUND Improving [Formula: see text] and reducing CO2 rebreathing ([Formula: see text]) are the key means to improve the therapeutic efficacy of noninvasive ventilation (NIV). This study aimed to investigate the impact of interface design on [Formula: see text] and [Formula: see text] during NIV. METHODS A simulated lung model was established to analyze 17 different interfaces. CO2 was injected into the outlet of the simulated lung, and the noninvasive ventilator was connected to the simulated lung to simulate the application of NIV in patients with COPD with hypercapnia. [Formula: see text] and [Formula: see text] were calculated by mathematical integration of synchronously collected data pertaining to real-time pressure, flow, oxygen concentration, and CO2 concentration in the breathing circuit. Comparisons were performed between different types (nasal vs oronasal) and models of interfaces as well as between interfaces with different leak positions. Correlation of [Formula: see text] and [Formula: see text] with inner volume and leakage, respectively, and the correlation between [Formula: see text] and [Formula: see text] were analyzed. RESULTS [Formula: see text] levels were significantly different with a nasal or an oronasal mask (0.45 ± 0.05% vs 0.41 ± 0.08%, respectively; P < .001). [Formula: see text] levels associated with different models of interfaces varied significantly (all P < .001); [Formula: see text] did not differ significantly among the different interfaces (P = .19). Leak position significantly affected [Formula: see text] and [Formula: see text] (all P < .001). Both inner volume and leakage significantly correlated with [Formula: see text] (r = -0.23, P < .001; r = -0.08, P = .02). There was a significant correlation between [Formula: see text] and [Formula: see text] (r = 0.43, P < .01); the general linear equation was y = 0.17 + 0.02x (r = 0.43, R2 = 0.19). CONCLUSIONS The design of the interface had a significant impact on [Formula: see text] and [Formula: see text] during NIV. [Formula: see text] and [Formula: see text] showed a significant positive correlation, although the effect size of correlation was moderate.
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Affiliation(s)
- Li-Li Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China.
| | - Jie Lu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin-Yu Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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Madeiro F, Andrade RGS, Piccin VS, Pinheiro GDL, Moriya HT, Genta PR, Lorenzi-Filho G. Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA. Chest 2019; 156:1187-1194. [PMID: 31238041 DOI: 10.1016/j.chest.2019.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/27/2019] [Accepted: 05/27/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND An oronasal mask is frequently used to treat OSA. In contrast to nasal CPAP, the effectiveness of oronasal CPAP varies by unknown mechanisms. We hypothesized that oral breathing and pressure transmission through the mouth compromises oronasal CPAP efficacy. METHODS Thirteen patients with OSA, well adapted to oronasal CPAP, were monitored by full polysomnography, pharyngeal pressure catheter, and nasoendoscope. Patients slept with low doses of midazolam, using an oronasal mask with sealed nasal and oral compartments. CPAP was titrated during administration by the oronasal and nasal routes, and was then reduced to induce stable flow limitation and abruptly switched to the alternate route. In addition, tape sealing the mouth was used to block pressure transmission to the oral cavity. RESULTS Best titrated CPAP was significantly higher by the oronasal route rather than the nasal route (P = .005), and patients with > 25% oral breathing (n = 5) failed to achieve stable breathing during oronasal CPAP. During stable flow limitation, inspiratory peak flow was lower, driving pressure was higher, upper airway inspiratory resistance was higher, and retropalatal and retroglossal area were smaller by the oronasal rather than nasal route (P < .05 for all comparisons). Differences were observed even among patients with no oral flow and were abolished when tape sealing the mouth was used (n = 6). CONCLUSIONS Oral breathing and transmission of positive pressure through the mouth compromise oronasal CPAP.
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Affiliation(s)
- Fernanda Madeiro
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafaela G S Andrade
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vivien S Piccin
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - George do Lago Pinheiro
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Henrique T Moriya
- Laboratório de Engenharia Biomédica, Escola Politécnica, Universidade de São Paulo, São Paulo, Brazil
| | - Pedro R Genta
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Goh KJ, Soh RY, Leow LC, Toh ST, Song PR, Hao Y, Lee KCH, Tan GL, Ong TH. Choosing the right mask for your Asian patient with sleep apnoea: A randomized, crossover trial of CPAP interfaces. Respirology 2018; 24:278-285. [PMID: 30189465 DOI: 10.1111/resp.13396] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE A major challenge with the treatment of obstructive sleep apnoea (OSA) is adherence to continuous positive airway pressure (CPAP) therapy. Mask tolerability is an important determinant of adherence, however evidence to guide selection of mask interfaces is lacking. METHODS We conducted a randomized crossover trial of mask interfaces in CPAP therapy for moderate-to-severe OSA to assess adherence and efficacy of CPAP therapy with nasal mask, nasal pillow and oronasal masks. Demographic data, Nasal Obstruction Symptom Evaluation (NOSE) scores and craniofacial measurements were also analysed for associations with adherence with oronasal masks. RESULTS Eighty-five patients were included in the study (mean ± SD age: 46 ± 12 years; body mass index: 29.9 ± 5.6 kg/m2 ; apnoea-hypopnoea index (AHI): 53.6 ± 24.0 events/h). Patients had better adherence with nasal masks (average night use: 3.96 ± 2.26 h/night) compared to oronasal masks (3.26 ± 2.18 h/night, P < 0.001) and nasal pillows (3.48 ± 2.20 h/night, P = 0.007). Residual AHI was higher with oronasal masks (7.2 ± 5.2) compared to nasal masks (4.0 ± 4.2, P < 0.001) and nasal pillows (4.1 ± 3.3, P < 0.001). Twenty-two (25.9%) patients had the best adherence with oronasal masks (4.22 ± 2.14 vs 2.93 ± 2.12 h/night, P = 0.016). These patients had lower NOSE scores (15 (0-35) vs 40 (10-55), P = 0.024) and larger menton-labrale inferioris/biocular width ratios (31 ± 3% vs 28 ± 4%, P = 0.019). CONCLUSION Nasal masks are the preferred interface during CPAP initiation. Patients with less nasal obstruction and a proportionally increased chin-lower lip distance to mid-face width may have better CPAP adherence with an oronasal mask interface.
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Affiliation(s)
- Ken Junyang Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Rui Ya Soh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Sleep Disorder Unit, Singapore General Hospital, Singapore
| | - Leong Chai Leow
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Sleep Disorder Unit, Singapore General Hospital, Singapore
| | - Song Tar Toh
- Sleep Disorder Unit, Singapore General Hospital, Singapore.,Department of Otolaryngology, Singapore General Hospital, Singapore
| | - Pei Rong Song
- Sleep Disorder Unit, Singapore General Hospital, Singapore
| | - Ying Hao
- Health Services Research Unit (HSRU), Division of Medicine, Singapore General Hospital, Singapore
| | - Ken Cheah Hooi Lee
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Gan Liang Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Thun How Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Sleep Disorder Unit, Singapore General Hospital, Singapore
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Schell AE, Soose RJ. Positive airway pressure adherence and mask interface in the setting of sinonasal symptoms. Laryngoscope 2017; 127:2418-2422. [PMID: 28434204 DOI: 10.1002/lary.26486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 11/10/2016] [Accepted: 12/05/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Despite reports of lower positive pressure adherence rates with oronasal masks, patients with sinonasal problems are often prescribed this interface over a nasal interface. The aim of this study was to characterize the relationship between mask type and therapy adherence in the setting of sinonasal symptoms. STUDY DESIGN Retrospective case series with chart review. METHODS We reviewed 328 patients who underwent positive pressure titration between January 2012 and May 2015. Follow-up adherence data were available for 218 patients (66.5%). Multivariate analysis examined whether patients with sinonasal symptoms have improved adherence with oronasal masks compared to nasal or nasal pillow interfaces. RESULTS At a median follow-up of 95 days, positive pressure adherence in patients with sinonasal symptoms was highest with the nasal pillow interface. When compared with oronasal interfaces, the odds of adequate therapy adherence were >5 times greater with nasal pillow interfaces (odds ratio [OR] = 5.20, 95% confidence interval [CI] = 1.61-16.80, P = .006) and >3 times greater with nasal interfaces (OR = 3.67, 95% CI = 1.20-11.26, P = .02) in these symptomatic patients. CONCLUSIONS The presence of nasal problems does not predict the need for an oronasal mask. Positive pressure adherence rates are higher with nasal and nasal pillow interfaces compared to oronasal masks, even in patients with sinonasal complaints. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2418-2422, 2017.
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Affiliation(s)
- Amy E Schell
- UPMC Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A
| | - Ryan J Soose
- UPMC Department of Otolaryngology, Pittsburgh, Pennsylvania, U.S.A
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Deshpande S, Joosten S, Turton A, Edwards BA, Landry S, Mansfield DR, Hamilton GS. Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea. J Clin Sleep Med 2016; 12:1263-8. [PMID: 27448430 DOI: 10.5664/jcsm.6128] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/06/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Oronasal masks are frequently used for continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). The aim of this study was to (1) determine if CPAP requirements are higher for oronasal masks compared to nasal mask interfaces and (2) assess whether polysomnography and patient characteristics differed among mask preference groups. METHODS Retrospective analysis of all CPAP implementation polysomnograms between July 2013 and June 2014. Prescribed CPAP level, polysomnography results and patient data were compared according to mask type (n = 358). RESULTS Oronasal masks were used in 46%, nasal masks in 35% and nasal pillow masks in 19%. There was no difference according to mask type for baseline apnea-hypopnea index (AHI), body mass index (BMI), waist or neck circumference. CPAP level was higher for oronasal masks, 12 (10-15.5) cm H2O compared to nasal pillow masks, 11 (8-12.5) cm H2O and nasal masks, 10 (8-12) cm H2O, p < 0.0001 (Median [interquartile range]). Oronasal mask type, AHI, age, and BMI were independent predictors of a higher CPAP pressure (p < 0.0005, adjusted R(2) = 0.26.). For patients with CPAP ≥ 15 cm H2O, there was an odds ratio of 4.5 (95% CI 2.5-8.0) for having an oronasal compared to a nasal or nasal pillow mask. Residual median AHI was higher for oronasal masks (11.3 events/h) than for nasal masks (6.4 events/h) and nasal pillows (6.7 events/h), p < 0.001. CONCLUSIONS Compared to nasal mask types, oronasal masks are associated with higher CPAP pressures (particularly pressures ≥ 15 cm H2O) and a higher residual AHI. Further evaluation with a randomized control trial is required to definitively establish the effect of mask type on pressure requirements. COMMENTARY A commentary on this article appears in this issue on page 1209.
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Affiliation(s)
- Sheetal Deshpande
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Simon Joosten
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia
| | - Anthony Turton
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology Monash University, Melbourne, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Shane Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology Monash University, Melbourne, Victoria, Australia
| | - Darren R Mansfield
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Victoria, Australia.,School of Clinical Sciences, Monash University, Victoria, Australia
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Zhang J, Wang Y, Cao J, Chen BY, Feng J. Noninvasive ventilation with complex critical care ventilator in the treatment of acute exacerbation of chronic obstructive pulmonary disease. J Int Med Res 2014; 42:1102-9. [PMID: 25080920 DOI: 10.1177/0300060514543037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the clinical effect of noninvasive positive-pressure ventilation (NIPPV), delivered via critical care ventilator or miniventilator, in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Prospective comparison study. Patients with AECOPD underwent NIPPV via: miniventilator with BiLevel positive airway pressure (BiPAP; Group A); critical care ventilator with pressure support ventilation and positive end expiratory pressure (PSV + PEEP; Group B); critical care ventilator with pressure-synchronized intermittent mandatory ventilation (P-SIMV)+PSV + PEEP (Group C). Physiological parameters were recorded before, during and after ventilation. RESULTS Patients in Group C (n = 21) showed significantly better improvements in physiological parameters (compared with pretreatment values) than those in Group B (n = 20) or Group A (n = 22). CONCLUSION NIPPV delivered via critical care ventilator has a better treatment effect than miniventilator NIPPV in patients with AECOPD. The use of P-SIMV + PSV + PEEP mode provides a significantly better treatment effect than PSV + PEEP alone.
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Affiliation(s)
- Jing Zhang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Wang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Cao
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Bao-Yuan Chen
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Feng
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, China Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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Yamaguti WP, Moderno EV, Yamashita SY, Gomes TG, Maida ALV, Kondo CS, de Salles IC, de Brito CM. Treatment-related risk factors for development of skin breakdown in subjects with acute respiratory failure undergoing noninvasive ventilation or CPAP. Respir Care 2014; 59:1530-6. [PMID: 24894664 DOI: 10.4187/respcare.02942] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) has been recognized as an effective strategy in preventing endotracheal intubation in subjects with acute respiratory failure (ARF). Some interface-related complications have also been recognized, such as skin breakdown (SB). The aim of this study was to determine the frequency of SB and identify potential treatment-related risk factors for its development in adults with ARF undergoing NIV or CPAP. METHODS A cross-sectional study was conducted in a general hospital. Subjects were retrospectively enrolled in this study if they were > 18 y old and developed ARF caused by any condition in which NIV or CPAP was indicated for at least one application for a period longer than 2 h. The outcomes were the prevalence of SB and the evaluation of related risk factors. Data were extracted from the electronic medical records. A stepwise forward logistic regression model was used to identify independent risk factors for SB development. RESULTS A total of 375 subjects (160 males) met the inclusion criteria and were enrolled in the study. Fifty-four subjects (14.4%) developed SB. The mean number of applications of NIV or CPAP carried out for > 2 h was higher in subjects with SB (7.1 ± 13.3 h) than in those without SB (4.4 ± 13.3 h) (P = .03). Subjects with SB also presented a higher total duration of NIV use (44.6 ± 118.5 h) compared with subjects without SB (21.8 ± 45.5 h) (P = .01). Subjects who developed SB presented a higher use of oronasal mask (92.6%) compared with the group that did not (21.5%) (P < .001). CONCLUSIONS In patients with ARF undergoing NIV or CPAP, oronasal mask use for > 26 h was independently associated with development of SB.
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Affiliation(s)
- Wellington P Yamaguti
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Eliana V Moderno
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Sandra Y Yamashita
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Thelma Gmc Gomes
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Ana Lígia V Maida
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Claudia S Kondo
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Isabel Cd de Salles
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Christina Mm de Brito
- Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil
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