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Abstract

Introduction: Device related pressure ulcers (PUs) from non-invasive ventilation (NIV) masks result in skin integrity alterations and patient discomfort. NIV mask related PU rates in our ICUs were above national PU benchmarks The primary purpose of the study was to examine PU outcomes and comfort of patients using a nasal-oral (N-O) mask (Performatrak, Respironics, Philips Healthcare) compared to a full face (FF) mask (Performax, Philips Healthcare). Methods: A before-after study of a convenience sample of patients with NIV orders in 5 ICUs was conducted. Two groups of 100 subjects each received either the N-O mask (first group) or the FF mask. Skin was assessed prior to mask application and every 12 hours and with mask removal. Comfort levels were assessed every 12 hours on a 1-5 Likert Scale (1 most comfortable). Adherence time was recorded every 12 hours. Data on the following variables were also recorded: indication for NIV, reason for study exit, total NIV days, invasive mechanical ventilation (MV) requirements, and demographic information. Results: In the N-O group, 20% developed a facial PU (16 Stage I and 4 Stage II); in the FF mask group, 1% developed a facial PU (Stage II) and 1% developed a scalp PU under the mask strap (p < .001). Comfort scores were significantly lower (more comfortable) with the FF mask (mean 1.9 ± 1.1) compared to N-O mask (mean 2.7 ± 1.2, p < .001). There was no significant difference in mean hours worn or % adherence: 28.9 hours ± 27.2, 92% for FF and 25 ± 20.7, 92% for N-O. Total NIV days (p <.001) and need for subsequent NIV (p = .022) were significantly higher with N-O mask due to switch to FF mask upon PU identification. No subjects who developed a PU with the N-O mask developed a PU with the FF mask. No significant differences between groups were found for ICU or hospital LOS, MV use prior or after NIV and total MV days, age, APACHE II, gender, race or indication for NIV. Conclusions: The FF mask resulted in significantly less PUs and was more comfortable for patients. The FF mask is a reasonable alternative to traditional N-O masks to decrease NIV mask related PU incidence.