What is noninvasive ventilation? If you are a person who googles everything, then you will find that noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube). Now if you are a person that likes to look at books to get the answer, then David W. Chang wrote in Clinical Application of Mechanical Ventilation that “noninvasive positive pressure ventilation is a technique of providing ventilation without the use of an artificial airway.
Whatever you want the definition to be, the purpose is all the same: to help the ventilation of the patient without having an artificial airway. Now that does not sound too bad, but what about when a person has to be on this ventilation for long periods of time? What happens to the patient’s face from having that mask sit against it for hours at a time? Not every medical practice can be perfect and noninvasive ventilation has its downfalls too.
Having a mask sit on your face for hours on end can cause lesions on the skin that a patient will not want on his or her face, but is the mask the only way these lesions can happen? There are many different interfaces for noninvasive ventilation, so some may be less harmful than others. In this paper we will investigate all the different reasons a patient can get this discomfort from a mask. Now let’s say that a patient has gotten a lesion from being on mechanical ventilation for a while, how can a medical profession help the patient recover from this?
Can medical professionals prevent the discomfort from the mask? With the medical field always advancing, people have developed pieces to help the discomfort. Let’s investigate the devices that can be placed to prevent or lessen the chance of discomfort and a lesion on a patient. I know there are a lot of questions so far to think about on the topic of noninvasive ventilation, but most people will still pick it over invasive, even with the thought of a lesion appearing on their face. Now that all these questions are floating through your head, let’s investigate the answers.
Causes of these lesions The authors of Treatment-Related Risk Factors for Development of Skin Breakdown in Patients With Acute Respiratory Failure Undergoing Noninvasive Ventilation or CPAP wrote “One of the most serious interface-related complications is the development of skin breakdown in the regions of greatest contact pressure between the mask and the patient’s skin. ” In other words, the pressure that the person needs to breath may be helping his or her lungs, but could be harming the face.
With a face mask the pressure covers the nose and the mouth, but also has straps that go over the forehead and cheeks and can cause pressure to go over those places too. Anywhere the mask comes in contact with the skin causes a complication of skin breakdown. Another reason for skin breakdown is the amount of time the patient has to wear the mask. Anne-Kathrin Brill wrote in How to avoid interface problems in acute noninvasive ventilation that “Interface-related pressure ulcers are medical-device related pressure ulcers and the longer the treatment lasts the more likely they are to develop.
A number of patient-dependent risk factors facilitate their occurrence, but the literature shows that the main cause for theses pressure ulcers is often associated with a lack of understanding of how and how often to remove devices and inspect the skin, and how to ensure the device fits appropriately to minimise friction and pressure. ” When a patient needs noninvasive ventilation it means that he or she is having a hard time breathing, but that does not mean he or she needs to have the mask on every second.
Changing from a mask to a different interface periodically can help lessen the chances skin breakdown. If the mask is not the correct size, it can cause skin break down faster. When a mask is too big it can cause the pressure to go all over the area and that does not help the patient. If a mask is too small all the pressure is set in one area and this can cause skin breakdown to excessively happen in this area. The wrong style of mask can speed up skin breakdown also. Not every person’s face is the same, so not every interface is going to fit correctly.
If a person cannot fit into the mask comfortably, the chances of a lesion are increased. The authors of the first article believe that another factor that could influence the development of skin breakdown is BMI. BMI is a person’s body mass index. They wrote, “It could be expected that individuals with higher BMI would need a higher clamping pressure of the mask against the face. ” This may be the case, but there is not enough information on the topic to know for sure. Helpful Devices
Most people do not want the lesion or ulcer in the first place, so people have developed pieces to help try and lessen or prevent the skin breakdown. When trying to prevent skin break down the first steps should include keeping the skin clean and dry. The second step in trying the lessen the chance of skin breakdown is the mask size. Anne-Kathrin Brill also stated, “The correct size of mask and headgear with a higher number of attachment points will help distribute the pressure more evenly around the circumference of the mask.
When a mask fits correctly the pressure applied to the face does not have to go to one spot. The first authors wrote, “Furthermore, in patients who require prolonged intermittent mandatory ventilation, rotating the use of different types of masks may be another strategy for decreasing these problems. If the patient is able to have different interfaces, then rotating from a mask to nasal pillows or a full face mask can help lessen the strain on the face. This may not be for every patient, but the ones that can use this technique may benefit.
Anne-Kathrin Brill wrote “Pads or foam, hydrocolloids, or gel distribute the pressure, reduce friction, and can also reduce small air leaks at the same time. ” These devices help lessen the pressure on the skin and add support where is needed. Any of these devices can be placed on the skin in places that get the most pressure so that the skin can get a break. Patients may have preferences or medical reasons to pick a certain dressing, but all of these can help with the skin breakdown. Conclusion When a patient needs ventilation support, the first choice is noninvasive.
This sounds simple, but every choice has consequences and noninvasive ventilation is no different. When a person is set up in ventilation, he or she faces the chance of getting skin breakdown and producing an ulcer. Some of the ways a patient can get these lesions or ulcers is from having the pressure set too high, wearing the mask for long periods of time without a break, if the mask does not fit properly, and in some cases the body mass index, however, that has not been proven yet. Any one of these could cause skin breakdown and there are ways to lessen the severity of the skin break down.
If the patient has the correct mask size, alternates between the different interfaces available, and used the foam, gel, or pads then the skin breakdown can be helped. In the beginning of this paper I asked a lot of questions, but throughout this paper the investigation for the answers happened. Skin breakdown is not something to mess with, but when the patient needs to be on ventilation it is not something they think about. Helpful pieces are forgotten in the rush to get the patient in a safe state, but once that happens lessening the breakdown is not that hard.