Pressure Ulcer Incidence with Patients Wearing Nasal/Oral Compared to Full Face Non-Invasive Ventilation Masks

Purpose: Device related pressure ulcers (PUs) from non-invasive ventilation (NIV) masks result in skin integrity alterations. NIV mask related PU rates in our ICUs were above national PU benchmarks. The purpose of the study was to examine PU outcomes using a nasal-oral (N-O) mask compared to a full face (FF) mask.

Methods: A before-after study of a convenience sample of patients with NIV orders in 5 ICUs was conducted. Two groups of 100 subjects received either the N-O mask (first group) or the FF mask. Skin was assessed prior to mask application and every 12 hours or with mask removal. Adherence time was recorded every 12 hours. Data on the following variables were recorded: indication for NIV, reason for study exit, total NIV days, invasive mechanical ventilation (MV) requirements, and demographic information.

Results:  In the N-O group, 20% developed a facial PU (16 Stage I and 4 Stage II).  The majority of PU’s were on the nasal bridge. In the FF mask group, 1% developed a facial PU (Stage II) and 1% developed a scalp PU under the mask strap (p < .001). Comfort scores were significantly lower with FF (p < .001). There was no significant difference in mean hours worn or % adherence: 28.9 hours ± 27.2, 92% for FF and 25 ± 20.7, 92% for N-O.  No subjects who developed a PU with the N-O mask developed a PU with the FF mask. No significant differences between groups were found for ICU or hospital LOS, MV use prior or after NIV and total MV days, age, APACHE II, gender, race or indication for NIV.

Conclusion:  The FF mask resulted in significantly less PUs and was more comfortable for patients. The FF mask is a reasonable alternative to traditional N-O masks to prevent NIV mask related PU development.