Full Mask Ventilation

Abstract

Noninvasive positive pressure ventilation (NPPV) has become an integral part of ventilator support in patients with either acute or chronic respiratory failure. NPPV has been shown to avoid the need for invasive mechanical ventilation, it’s associated complications and facilitate successful extubation in patients with chronic obstructive pulmonary disease (COPD) who have marginal weaning parameters. In addition, some studies [1–3] have shown that NPPV improves survival compared with invasive mechanical ventilation in patients with acute respiratory failure. Moreover, NPPV has been shown to be an effective modality for the treatment of chronic respiratory failure in patients with restrictive ventilatory disorders [4–6] and in selected patients with COPD [7, 8]. Compared with invasive ventilation, NPPV decreased the risk of ventilator-associated pneumonia and optimized comfort. Because of its design, success depends largely on patient cooperation and acceptance. Some factors that may limit the use of NPPV are mask- (or interface-) related problems such as air leaks, mask intolerance due to claustrophobia and anxiety, and poorly fitting mask. Approximately 10–15% of patients fail to tolerate NPPV due to problems associated with the mask interface despite adjustments in strap tension, repositioning, and trial of different types of masks. Other mask-related problems include facial skin breakdown, aerophagia, inability to handle copious secretions, and mask placement instability. The most commonly used interfaces in both acute and long-term settings are nasal and nasal-oral (NO) masks. The following reviews the applications of full-face mask in patients who are unable to tolerate a conventional mask during NPPV.