Facial pressure ulcers amongst children on long term non-invasive ventilation: incidence and management strategies

Abstract

Background: A well-fitted, comfortable mask is crucial in delivering effective non-invasive ventilation (NIV), thereby promoting adherence. Data on incidence, severity of mask-related pressure ulcers (PU) and its management in children on long term NIV is limited. Aim: To identify the incidence of PU and review the experience of managing PU amongst children on long term NIV at a large tertiary centre. Method: Retrospectve review of medical records and databases. Results: Between 2012-2016, 558 patients on long term NIV were seen by the NIV service. 87 cases of mask-related PU were identified. Its incidence varied from 14-21 cases/year(4.4-7.8%/year).Affected patients ranged [IQR]0.5-18.2 [3.8-14.1]years, with underlying conditions: neuromuscular diseases (42.5%), respiratory (19.5%), craniofacial syndromes(13.7%) and other neurological conditions(12.6%), most of whom were nocturnal NIV users(83.9%). PU occurred mainly in nasal bridge(67.8%), nose(8%), forehead(6.9%). The cases consisted of grade 1(77%), grade 2(19.5%) and 3 (3.5%) PU. The types of masks worn when PU developed, were nasal (59.8%), oronasal (36.8%), total face masks (2.3%) and nasal pillow (1.1%).22% of PU occurred within the first 90 days of using NIV. The 3 most common actions taken were (1)using Siltape (34.5%);(2)switching to a different type of mask(19.5%);(3)both of above(11.5%). 98% of cases resolved. Conclusion: Incidence of PU in our NIV cohort has declined over time (7.8% in 2012 to 4.6% in 2016). The increased incidence of Grade 1 PU with concurrent decline in Grade 2/3 PU is likely due to more frequent surveillance with increased service provision, enabling earlier detection and intervention.