The role of Noninvasive Ventilation (NIV) with humidification in the development of facial pressure ulcers
The role of Noninvasive Ventilation (NIV) with humidification in the development of facial pressure ulcers
Rationale
The use of noninvasive ventilation (NIV) masks have been implicated in damaging facial skin tissue, consequently having a considerableeffect on patients’ quality of life and wound care. The use of humidification with NIV is common practice, but its role in the developmentof facial pressure ulceration, has not been studied.
Methods
A crossover cohort design was used in this study, with 15 healthy volunteers serving as their own controls, randomly receiving both 10cmH2O of continuous positive airway pressure (CPAP) with humidification, and without through an oronasal mask. Skin integrity wasevaluated by measuring transepidermal water loss (TEWL), skin hydration and skin pH at the nose bridge. Device-skin interface conditions(pressure and microclimate) were recorded at the bridge of the nose and both cheeks. The pro-inflammatory cytokine Interleukin 1α(IL-1α) was collected from the nose bridge before and after CPAP application using Sebutape. Nasal symptom scoring was collected usinga six-point nasal score.
Results
Humidified CPAP significantly increases TEWL (P<0.001) and skin humidity (P<0.02) compared to non-humidified CPAP (table 1). Therewere no significant differences in skin hydration, skin pH, skin temperature and cytokine expression between both conditions. However,higher mean ratios of Interleukin-1α concentrations were recorded following humidified CPAP application. There was a significantincrease in the interface pressure at the nose bridge following CPAP application (P<0.04), with higher baseline interface pressure at thenose bridge comparing with left (P<0.003) and right (P<0.006) cheeks. Non-humidified CPAP elevated nasal discomfort, as reported by theparticipants.
Conclusion
These findings indicate that humidification with NIV has a significant disrupting effect on the barrier function of facial skin, associated withsignificant changes in skin microclimate and function. Prophylactic strategies to maintain dry skin and manage the microclimate betweenthe skin and the mask are required to safeguard skin integrity.
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10
Alqahtani, Jaber S.
1b64f1a5-b742-4d95-a605-2493856180ad
23 May 2017
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10
Alqahtani, Jaber S.
1b64f1a5-b742-4d95-a605-2493856180ad
Worsley, Peter, Voegeli, David and Alqahtani, Jaber S.
(2017)
The role of Noninvasive Ventilation (NIV) with humidification in the development of facial pressure ulcers.
American Thoracic Society, , Washington, DC, United States.
21 - 24 May 2017.
Record type:
Conference or Workshop Item
(Paper)
Abstract
Rationale
The use of noninvasive ventilation (NIV) masks have been implicated in damaging facial skin tissue, consequently having a considerableeffect on patients’ quality of life and wound care. The use of humidification with NIV is common practice, but its role in the developmentof facial pressure ulceration, has not been studied.
Methods
A crossover cohort design was used in this study, with 15 healthy volunteers serving as their own controls, randomly receiving both 10cmH2O of continuous positive airway pressure (CPAP) with humidification, and without through an oronasal mask. Skin integrity wasevaluated by measuring transepidermal water loss (TEWL), skin hydration and skin pH at the nose bridge. Device-skin interface conditions(pressure and microclimate) were recorded at the bridge of the nose and both cheeks. The pro-inflammatory cytokine Interleukin 1α(IL-1α) was collected from the nose bridge before and after CPAP application using Sebutape. Nasal symptom scoring was collected usinga six-point nasal score.
Results
Humidified CPAP significantly increases TEWL (P<0.001) and skin humidity (P<0.02) compared to non-humidified CPAP (table 1). Therewere no significant differences in skin hydration, skin pH, skin temperature and cytokine expression between both conditions. However,higher mean ratios of Interleukin-1α concentrations were recorded following humidified CPAP application. There was a significantincrease in the interface pressure at the nose bridge following CPAP application (P<0.04), with higher baseline interface pressure at thenose bridge comparing with left (P<0.003) and right (P<0.006) cheeks. Non-humidified CPAP elevated nasal discomfort, as reported by theparticipants.
Conclusion
These findings indicate that humidification with NIV has a significant disrupting effect on the barrier function of facial skin, associated withsignificant changes in skin microclimate and function. Prophylactic strategies to maintain dry skin and manage the microclimate betweenthe skin and the mask are required to safeguard skin integrity.
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More information
Accepted/In Press date: 23 January 2017
Published date: 23 May 2017
Additional Information:
American Journal of Respiratory and Critical Care Medicine 2017;195:A6565
Venue - Dates:
American Thoracic Society, , Washington, DC, United States, 2017-05-21 - 2017-05-24
Identifiers
Local EPrints ID: 413663
URI: http://eprints.soton.ac.uk/id/eprint/413663
PURE UUID: 84ba6821-2f3c-42e6-9873-70e004fb26de
Catalogue record
Date deposited: 31 Aug 2017 16:31
Last modified: 12 Dec 2021 03:42
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Contributors
Author:
David Voegeli
Author:
Jaber S. Alqahtani
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