Neonatal Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.

Abstract

The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive ventilation (NIV). Since most patients receive nasal bubble CPAP (a form of NIV), a concomitant increase in nasal pressure injuries followed. This prospective observational study aims to develop strategies to reduce nasal mask pressure injury in neonates by 1.) quantifying CPAP mask-interface pressure and 2.) assessing placement variability. A 1F MEMS Connect pressure sensor (Millar®) was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cmH2O and 8 L/min of flow with no humidification. Pressure was measured at three locations (the forehead, nasal bridge, and philtrum) in triplicate (three measurements per site). Descriptive statistics, a location-specific, one-way analysis of variance (ANOVA) with a Tukey post hoc test, and a two-sample paired t-test of the means of the first and last triplicate were performed (Minitab, LLC). Pressure ranged from 12.3 to 377.3 mmHg. The mean (SD) interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum: 173.9 (101.3), nasal bridge: 67.79 (28.9), and forehead 79.02 (36.87), p ˂ 0.001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.