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Pressure ulcers
Clinical/pre-clinical research

Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial

02 May 2020
Research
02 May 2020
Volume 4 · Issue 2

Abstract

Objective:

To comparatively assess the efficacy of four different therapeutic strategies to prevent the development of facial pressure ulcers (FPUs) related to the use of non-invasive mechanical ventilation (NIV) with oro-nasal masks in critically ill hospitalised patients.

Method:

This randomised control trial was performed at the high dependency unit in the University General Hospital Gregorio Marañón in Madrid, Spain. Overall, 152 patients with acute respiratory failure were recruited. All patients were hospitalised and received NIV through oro-nasal masks. The Norton tool was used to evaluate the general risk of developing pressure ulcers (PUs). Subjects were divided into four groups, each of them receiving a different treatment. Tissue assessment and preventive care were performed by a member of the research team.

Results:

The incidence of FPUs was significantly lower in the group receiving a solution of hyperoxygenated fatty acids (HOFA) when compared with each of the other therapeutic strategies: direct mask (p=0.055), adhesive thin dressing (p=0.03) and adhesive foam dressing (p<0.001).

Conclusion:

The application of HOFA on the facial skin in contact with the oro-nasal masks showed the highest efficacy in the prevention of NIV-related FPUs.

A relatively important number of medical devices, such as ventilators, ventilation masks, catheters and tubes, are used in the management of critically ill patients. When used appropriately, these devices are expected to produce low levels of pressure on the skin. However, these patients' critical condition increases the risk of developing medical device-related pressure ulcers (PUs).

A medical device-related PU is defined as a localised injury to the skin or underlying tissue as a result of sustained pressure from a medical device.1 The skin/tissue injury will often have the same configuration (shape) as the device. Medical device-related PUs are now included in hospital-acquired PU quality reported metrics.1,2 Facial pressure ulcers (FPUs) usually need an associated risk factor for their development, and this is the case with ventilation masks and other similar medical devices.

Non-invasive mechanical ventilation (NIV) represents an effective strategy to prevent endotracheal intubation and has become an integral tool in the management of patients with acute and chronic respiratory failure.3,4 NIV can be defined as the provision of ventilatory support to the patient's spontaneous breathing without using invasive artificial airways, such as endotracheal intubation, laryngeal masks or Combitube, using instead external devices known as interfaces (mouthpiece, nasal mask, face mask, helmet mask). As an effective strategy to avoid the risks associated with invasive ventilation,1 the advantages of NIV include a lower incidence of upper airways injury, laryngeal stenosis and nosocomial pulmonary infection, as well as a reduction in the need for sedative or paralytic drugs, hospital stays and mortality rates.5,6,7

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critical patients
facial pressure ulcer
non-invasive medical ventilation
randomised control trial