Providing Pressure Redistribution, Maintaining Skin Integrity, and Preventing Nasal/Facial Pressure Ulcers in Patients Being Treated with Continuous Noninvasive Positive Airway Pressure Ventilation

Noninvasive Positive Pressure Ventilation (NPPV) or Noninvasive Mask Ventilation (NIMV) is a widely recognized treatment for providing ventilary support, thus preventing the need for intubation in patients with acute respiratory failure. The use of NPPV has been shown to reduce the need for intubation, decrease mortality rates and decrease length of hospitalization in patients with exacerbation of COPD, acute cardiopulmonary edema and immunocompromised states (Liesching, et al, 2003 & Garpestad, et al, 2007). NPPV is also an effective treatment for weaning noninvasive ventilation. Complications from the use of this delivery modality, most often through orofacial mask, include nasal bridge or mucosal pain, nasal bridge erythema, and nasal bridge or facial pressure ulcers.  According to the National Pressure Ulcer Advisory Panel Stages/Categories of Pressure Ulcers, shallow pressure ulcers on the bridge of nose are often full thickness due to the lack of subcutaneous tissue.

The repercussions associated with pressure ulcers are great. Not only is the institution’s financial burden great, but more importantly, pressure ulcers have a major impact on a patient’s quality of life. The mortality rate directly associated with pressure ulcers is approximately 60,000 per year (AHRQ, retrieved 10/2011).  Implementing best practice measures is needed to reduce the incidence of pressure ulcers and improve the quality of care.

Three products (polymer gel nasal pad, silicone foam, glycerin-based hydrogel sheet) were evaluated over a six month period to determine which provided the most pressure redistribution to maintain skin integrity and prevent nasal/facial pressure ulcers in patients being treated with continuous noninvasive positive airway pressure ventilation. Based on the outcome (pressure ulcer development rate, ease of use, comfort) the author’s institutional protocol was modified to reduce potential complications associated with this therapy.