Full Face Mask Research Articles

Full-Face Mask Use during SCUBA Diving Counters Related Oxidative Stress and Endothelial Dysfunction.

Impaired flow mediated dilation (FMD), an index of vascular stress, is known after SCUBA diving. This is related to a dysfunction of nitric oxide (NO) availability and a disturbance of the redox status, possibly induced by hyperoxic/hyperbaric gas breathing. SCUBA diving is usually performed with a mask only covering “half face” (HF) and therefore forcing oral breathing. Nasal NO production is involved in vascular homeostasis and, as consequence, can significantly reduce NO possibly promoting vascular dysfunction. More recently, the utilization of “full-face” (FF) mask, allowing nasal breathing, became more frequent, but no reports are available describing their effects on vascular functions in comparison with HF masks. In this study we assessed and compared the effects of a standard shallow dive (20 min at 10 m) wearing either FF or a HF mask on different markers of vascular function (FMD), oxidative stress (ROS, 8-iso-PGF2α) and NO availability and metabolism (NO2, NOx and 3-NT and iNOS expression). Data from a dive breathing a hypoxic (16% O2 at depth) gas mixture with HF mask are shown allowing hyperoxic/hypoxic exposure. Our data suggest that nasal breathing might significantly reduce the occurrence of vascular dysfunction possibly due to better maintenance of NO production and bioavailability, resulting in a better ability to counter reactive oxygen and nitrogen species. Besides the obvious outcomes in terms of SCUBA diving safety, our data permit a better understanding of the effects of oxygen concentrations, either in normal conditions or as a strategy to induce selected responses in health and disease.

Elevated Residual Apnea-Hypopnea Index on Continuous Positive Airway Pressure Download after Transition to Full-Face Mask.

Elevated Residual Apnea-Hypopnea Index on Continuous Positive Airway Pressure Download after Transition to Full-Face Mask.

Surgical Performance Is Not Negatively Impacted by Wearing a Commercial Full-Face Mask with Ad Hoc 3D-Printed Filter Connection as a Substitute for Personal Protective Equipment during the COVID-19 Pandemic: A Randomized Controlled Cross-Over Trial.

(1) Background: During the COVID-19 pandemic, shortages in the supply of personal protective equipment (PPE) have become apparent. The idea of using commonly available full-face diving (FFD) masks as a temporary solution was quickly spread across social media. However, it was unknown whether an FFD mask would considerably impair complex surgical tasks. Thus, we aimed to assess laparoscopic surgical performance while wearing an FFD mask as PPE. (2) Methods: In a randomized-controlled cross-over trial, 40 laparoscopically naive medical students performed laparoscopic procedures while wearing an FFD mask with ad hoc 3D-printed connections to heat and moisture exchange (HME) filters vs. wearing a common surgical face mask. The performance was evaluated using global and specific Objective Structured Assessment of Technical Skills (OSATS) checklists for suturing and cholecystectomy. (3) Results: For the laparoscopic cholecystectomy, both global OSATS scores and specific OSATS scores for the quality of procedure were similar (Group 1: 25 ± 4.3 and 45.7 ± 12.9, p = 0.485, vs. Group 2: 24.1 ± 3.7 and 43.3 ± 7.6, p = 0.485). For the laparoscopic suturing task, the FFD mask group needed similar times to the surgical mask group (3009 ± 1694 s vs. 2443 ± 949 s; p = 0.200). Some participants reported impaired verbal communication while wearing the FFD mask, as it muffled the sound of speech, as well as discomfort in breathing. (4) Conclusions: FFD masks do not affect the quality of laparoscopic surgical performance, despite being uncomfortable, and may therefore be used as a substitute for conventional PPE in times of shortage—i.e., the global COVID-19 pandemic.

The Efficacy of Using Cloth, Surgical, KN95, N95 and Full-face Masks among Indonesian's Travellers in COVID-19 Era

Background: The Effectiveness of Masks to Prevent COVID-19. During the Corona pandemic, masks became a very vital tool to prevent the spread of COVID-19. With the importance of using masks to prevent this Coronavirus, few circulate are circulating on the market. Like the cheapest and many people use is a cloth mask. However, many travelers are still confused about wearing so many variants that sell in the market nowadays. Aim: To know the best cover to reduce the probability of COVID 19 accidents among travelers in Indonesia. Methods: The travelers in Indonesia were asked by questionnaire about the mask chosen, symptoms, and the rapid test value. Result: 70.2% of Indonesian travellers without COVID 19 symptoms still use medical masks to prevent contracting the CoV2 virus. Conclusion: Medical covers are even suitable for use as a means of personal protection for travelers who want to travel. Apart from being cheap, these masks are readily available in many shopping centres and are comfortable to wear while traveling.

Investigation on and Protective Measures and Exposure Risks for the People Related to Medical Waste Disposal during the COVID-19 Epidemic

During the COVID-19, the production of medical waste increased sharply, which brought a challenge to the capacity of China's medical waste disposal and the protection of the group that received, transported and disposed of medical waste In order to study the potential risks and protection measures against exposure for the workers in the collection, transportation, temporary storage, and disposal of medical waste, ninety staff members from a typical medical waste disposal center in Zhejiang Province were selected as the research objects to study the personal protection level of staff in different types of work, as well as the influence of items or locations at risk of infection on their choice of protective measures The results show that among the 90 surveyed people, 98 9% of the staff wore medical respirators or full-face masks and half-masks during the work, 87 5% of the staff wore work clothes, 79 6% of the staff wore labor protection cap, 64 8% of workers chose to wear rubber gloves and protective boots for protection, and goggles (55 7%) and protective clothing (33 0%) were also worn when they were closely contact with medical waste At the end of a single task, 100% of the respondents chose to wash their hands with running water, soap, quick disinfectant or 0 3%-0 5% iodophor disinfectant or bathe, and 94 3% of the respondents disinfected their personal work items;all respondents would take protective measures such as washing hands, disinfecting items, ventilating after returning home The personal protection measures taken by different staff were mainly related to the items or locations that were exposed to risk of infection during the work process Among them, the staff who were in contact with high-risk items, turnover containers (barrels) or the outer surface and inner wall of disposable packaging containers were more inclined to a higher level of protective measures This research indicates that there is a significant difference between the qualified rate of protection and the type of work for the staff in this survey (P0 05) In the future, more detailed and specific policies and regulations should be formulated, and the management and training of the employees should be strengthened to increase their awareness of prevention and reduce the risk of occupational exposure © 2020, Editorial Board, Research of Environmental Sciences All right reserved

0530 Effect Of Changing From Nasal Interface To Full Face Mask On CPAP Efficacy At Various Pressure Settings

0530 Effect Of Changing From Nasal Interface To Full Face Mask On CPAP Efficacy At Various Pressure Settings

0529 Full Facemask Induced Upper Airway Obstruction During PAP Titrations: A Common Phenomenon Hindering PAP Treatment When Unrecognized And Indication For Combination Therapy With Oral Appliance Mandibular Stabilization

0529 Full Facemask Induced Upper Airway Obstruction During PAP Titrations: A Common Phenomenon Hindering PAP Treatment When Unrecognized And Indication For Combination Therapy With Oral Appliance Mandibular Stabilization

Pilot Study on Healthy Volunteers to Investigate the Implications of Expiratory Positive Airway Pressure Applied Via a Full-Face Mask on Capnographic Parameters and Subject Comfort Level

Pilot Study on Healthy Volunteers to Investigate the Implications of Expiratory Positive Airway Pressure Applied Via a Full-Face Mask on Capnographic Parameters and Subject Comfort Level

Treatment Failure of Continuous Positive Airway Pressure with a Full Face Mask, Reversed with a Nasal Mask

Treatment Failure of Continuous Positive Airway Pressure with a Full Face Mask, Reversed with a Nasal Mask

Work of breathing using different interfaces in spontaneous positive pressure ventilation: helmet, face-mask, and endotracheal tube.

Noninvasive positive pressure ventilation (NPPV) using a helmet is expected to cause inspiratory trigger delay due to the large collapsible and compliant chamber. We compared the work of breathing (WOB) of NPPV using a helmet or a full face-mask with that of invasive ventilation by tracheal intubation. We used a lung model capable of simulating spontaneous breathing (LUNGOO; Air Water Inc., Japan). LUNGOO was set at compliance (C)=50mL/cmH2O and resistance (R)=5cmH2O/L/s for normal lung simulation, C=20mL/cmH2O and R=5cmH2O/L/s for restrictive lung, and C=50mL/cmH2O and R=20cmH2O/L/s for obstructive lung. Muscle pressure was fixed at25cmH2O and respiratory rate at20bpm. Pressure support ventilation and continuous positive airway pressure were performed with each interface placed on a dummy head made of reinforced plastic that was connected to LUNGOO. We tested the inspiratory WOB difference between the interfaces with various combinations of ventilator settings (positive end-expiratory pressure 5cmH2O; pressure support 0, 5, and 10cmH2O). In the normal lung and restrictive lung models, WOB decreased more with the face-mask than the helmet, especially when accompanied by the level of pressure support. In the obstructive lung model, WOB with the helmet decreased compared with the other two interfaces. In the mixed lung model, there were no significant differences in WOB between the three interfaces. NPPV using a helmet is more effective than the other interfaces for WOB in obstructive lung disease.

BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults

### Principles of mechanical ventilation #### Modes of mechanical ventilation Recommendation 1. Pressure-targeted ventilators are the devices of choice for acute NIV (Grade B). Good practice points #### Choice of...

Domiciliary Non-Invasive Ventilation - Is There an Optimal Interface?Domiciliary Non-Invasive Ventilation - Is There an Optimal Interface?

Background and Aim: The purpose of our study was to ascertain if there were any advantages of the nasal mask (NM) when compared to the full face mask (FFM) interface for subjects requiring non-invasive home mechanical ventilation (NIHMV). Design and Methods: We retrospectively analysed 256 patients who were successfully initiated on domiciliary ventilation between May 2009 and August 2013. The interface initially selected was determined, along with any change in interface after 12 months, with gas exchange measurements after 12 and 24 months. Hospital admissions, inpatient days, levels of compliance and intolerance to NIHMV were recorded for each 12 month period. Results: Patients opting for the FFM interface used higher NIV pressures, although achieved similar improvements in gas exchange. Levels of compliance, intolerance, and reduction in burden on health care resources was similar at 24 months for each interface, regardless if any change in interface in the intervening period. Conclusion: There were no differences in overall effectiveness for either NM or FFM interface for people requiring NIHMV.

Upper Airway Obstruction during Noninvasive Ventilation Induced by the Use of an Oronasal Mask

In patients with neuromuscular disorders, no randomized studies have been performed whether nasal or oronasal masks should be preferred. Oronasal masks are often used in acute respiratory failure, while nasal masks are preferred in patients with chronic respiratory failure. However, the use of nasal masks can result in mouth leaks with implications on sleep quality. To reduce these leaks, oronasal masks have been applied during home noninvasive ventilation (NIV). Until now, upper airway obstruction during NIV has been thought to be induced by nasal obstruction, pharyngeal collapse, and/or glottis closure. We report a case indicating another cause of upper airway obstruction: use of an oronasal mask can induce obstructive events in the upper airways, possibly resulting in sleep fragmentation and decreased efficiency of NIV.

Effects of Muscle Relaxants on Mask Ventilation in Anesthetized Persons With Normal Upper Airway Anatomy

Background Recent studies suggest advantages of muscle relaxants for facemask ventilation. However, direct effects of muscle relaxants on mask ventilation remain unclear because these studies did not control mechanical factors influencing ventilation. We tested a hypothesis that muscle relaxants, either rocuronium or succinylcholine, improve mask ventilation. Methods In anesthetized adult persons with normal upper airway anatomy, tidal volumes during facemask ventilation were measured while maintaining the neutral head and mandible positions and the airway pressures of a ventilator before and during muscle paralysis induced by either rocuronium (n=14) or succinylcholine (n=17). Tidal volumes of oral and nasal airway routes were separately measured with a custom-made oronasal portioning full facemask. Behavior of the oral airway was observed by an endoscope in six additional subjects receiving succinylcholine. Results Total, oral, and nasal tidal volumes did not significantly change at complete muscle paralysis with rocuronium. In contrast, succinylcholine significantly increased total tidal volumes at 60 s after its administration (mean±SD; 4.2±2.1 vs. 5.4±2.6 ml/kg, P=0.02) because of increases of ventilation through both airway routes. Abrupt tidal volume increase occurred more through oral airway route than nasal route. Dilation of the space at the isthmus of the fauces was endoscopically observed during pharyngeal fasciculation in all six subjects. Conclusions Rocuronium did not deteriorate facemask ventilation, and it was improved after succinylcholine administration in association with airway dilation during pharyngeal fasciculation. This effect continued to a lesser degree after resolution of the fasciculation.

Effects of Muscle Relaxants on Mask Ventilation in Anesthetized Persons with Normal Upper Airway Anatomy

Recent studies suggest advantages of muscle relaxants for facemask ventilation. However, direct effects of muscle relaxants on mask ventilation remain unclear because these studies did not control mechanical factors influencing ventilation. We tested a hypothesis that muscle relaxants, either rocuronium or succinylcholine, improve mask ventilation. In anesthetized adult persons with normal upper airway anatomy, tidal volumes during facemask ventilation were measured while maintaining the neutral head and mandible positions and the airway pressures of a ventilator before and during muscle paralysis induced by either rocuronium (n=14) or succinylcholine (n=17). Tidal volumes of oral and nasal airway routes were separately measured with a custom-made oronasal portioning full facemask. Behavior of the oral airway was observed by an endoscope in six additional subjects receiving succinylcholine. Total, oral, and nasal tidal volumes did not significantly change at complete muscle paralysis with rocuronium. In contrast, succinylcholine significantly increased total tidal volumes at 60 s after its administration (mean±SD; 4.2±2.1 vs. 5.4±2.6 ml/kg, P=0.02) because of increases of ventilation through both airway routes. Abrupt tidal volume increase occurred more through oral airway route than nasal route. Dilation of the space at the isthmus of the fauces was endoscopically observed during pharyngeal fasciculation in all six subjects. Rocuronium did not deteriorate facemask ventilation, and it was improved after succinylcholine administration in association with airway dilation during pharyngeal fasciculation. This effect continued to a lesser degree after resolution of the fasciculation.

SU-E-J-68: An Optical Image Guidance System: To Detect Arbitrarily Attached Markers Behind a Full Facemask.

We developed an optical image guidance system to manage patient's inter-fractional set-up errors by tracking external markers at the specific positions (e.g., nose tip) behind a full facemask. However, a problem associated with the reproducibility of the marker positions during the entire course of treatments still remains. In order to remove this disadvantage, we applied the arbitrary-point-to-plane registration method to our existing system. Infra-red (IR) reflecting markers were attached on arbitrary positions of the head phantom's face and then the phantom was immobilized by a full face thermoplastic mask. 3D coordinates of the IR markers behind the full facemask were reconstructed by the calibrated stereo camera system using the direct linear transform (DLT) algorithm. In order to match arbitrarily attached markers with a planning CT image, rough positions of three markers were manually defined (rough registration) and then the coordinates of all markers were determined through the point-to-plane registration using the contractive projection point (CPP) algorithm (fine registration). In addition, the marker registration error in 6 DOF was calculated. In order to validate accuracy of the system, the phantom was intentionally moved according to 10 sets of known translation parameters. A mean target registration error (TRE) determined by the experiments for arbitrarily attached markers was 1.24 ± 0.32 mm. The fine registration following the rough registration allowed fast and robust registrations. The proposed solution for arbitrarily attached markers behind a full facemask enables us to avoid any daily errors in attaching the external markers at the specific positions. This work was supported in part by the SNU interdisciplinary project (2009-2010) and the SNU Brain Fusion project (2010-2011).

Negative pressure pulmonary edema with laryngeal mask airway use: Recognition, pathophysiology and treatment modalities

Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide.

Development of an Optical Image based Guidance System for Head and Neck Cancer Patients by Detecting External Markers behind a Full Facemask

Development of an Optical Image based Guidance System for Head and Neck Cancer Patients by Detecting External Markers behind a Full Facemask

Development of an optical-based image guidance system: Technique detecting external markers behind a full facemask

Optical image-guided systems (e.g., AlignRT, frameless SonArray, ExacTrac) have been used with advantages of avoiding excessive radiation exposure and real-time patient monitoring. Although these systems showed proven accuracy, they need to modify a full facemask for patients with H&N cancer and brain tumor. We developed an optical-based guidance system to manage interfractional and intrafractional setup errors by tracking external markers behind a full facemask. Infra-red (IR) reflecting markers were attached on the face of a head phantom and then the phantom was immobilized by a full face thermoplastic mask. A stereo camera system consisting of two CCD cameras was mounted on the inferior wall of treatment room. The stereo camera system was calibrated to reconstruct 3D coordinates of multiple markers with respect to the isocenter using the direct linear transform (DLT) algorithm. The real-time position of the phantom was acquired, through the stereo camera system, by detecting the IR markers behind the full facemask. The detection errors with respect to the reference positions of planning CT images were calculated in six degrees of freedom (6-DOF) by a rigid-body registration technique. The calibration accuracy of the system was in submillimeter (0.33 mm +/- 0.27 mm), which was comparable to others. The mean distance between each of marker positions of optical images and planning CT images was 0.50 mm +/- 0.67 mm. The maximum deviations of 6-DOF registration were less than 1 mm and 1 degrees for the couch translation and rotation, respectively. The developed system showed the accuracy and consistency comparable to the commercial optical guided systems, while allowing us to simultaneously immobilize patients with a full face thermoplastic mask.

Use of the Laryngeal Mask Airway and Bi-Level Positive Airway Pressure in Postoperative Airway Management

To the Editor A 134 kg (body mass index, 39 kg/m2) male with severe obstructive sleep apnea, multiple comorbidities, and inconsistent use of continuous positive airway pressure was scheduled for extensive spine surgery.1 After an uneventful induction of anesthesia and tracheal intubation, he was positioned prone on a Jackson frame. After 4.5 hours of surgery, during which he received 3600 mL crystalloid, he was turned supine and his trachea was extubated when he was fully awake and the residual neuromuscular block was reversed. His eyes and face were swollen and we did not perform a “leak test” to assess whether significant laryngeal edema was present. After 30 minutes in the recovery room, the patient was exhibiting signs of partial airway obstruction (SpO2, 92%–98%) despite a nasopharyngeal airway and manually applied mandibular advancement. Bilevel positive airway pressure (BiPAP Vision, Respironics, Murrysville, PA) using a full facemask with a (titrated) 20/10 cm H2O with 60% oxygen was applied, with little improvement.2 After an hour in the recovery room, his airway and level of consciousness had not improved, still being responsive to loud verbal stimuli. Although carbon dioxide retention was suspected, arterial blood gases were not measured. We did not administer naloxone because of his risk of coronary artery disease. Because we anticipated a likely difficult intubation if we attempted to place an endotracheal tube, we elected to insert a #5 LMA Unique™ (LMA North America, San Diego, CA) to treat the partial airway obstruction. With verbal stimulation and without topical anesthesia or additional sedation, he cooperated by swallowing during insertion of the LMA. Spontaneous ventilation was then assisted with BiPAP 10/5 cm H2O and 60% fraction of inspired oxygen.3,4 Two hours later, without opioids or sedatives, he was alert, cooperative, and comfortable, and facial edema had receded. The LMA was removed with no further complications. This case represents an example of the temporary use of a “supraglottic airway BiPAP” system to treat the postextubation airway obstruction and respiratory failure in an awake, spontaneously breathing, obese patient with obstructive sleep apnea after unsuccessful application of “facemask BiPAP.” When correctly positioned, supraglottic airways will provide an oropharyngeal seal compatible with the use of noninvasive positive pressure ventilation and may be better tolerated and more effective than the nasal or facial mask BiPAP/continuous positive airway pressure interface. John Boncyk, MD Adrian A. Matioc, MD Kathleen Harden, CRNA William S. Middleton Memorial Veterans Medical Center Department of Anesthesiology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin [email protected]