The effect of humidified noninvasive ventilation (NIV) on the development of facial skin breakdown

Abstract

Background

The use of noninvasive ventilation (NIV) masks is known to cause damage to facial skin tissues, affecting both the efficacy of the intervention and patients’ quality of life. The use of humidification with NIV is a common practice, but its relative role in the development of facial pressure ulcers has not been fully studied.

Methods

A crossover cohort design was used in this study with 15 healthy volunteers. Each volunteer was randomly receiving both 10 cmH2O of continuous positive airway pressure (CPAP) with and without humidification through an oronasal mask. Skin integrity was evaluated 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 IL-1α was collected from the nose bridge before and after CPAP application using Sebutape®. Nasal symptoms were collected using a validated six-point score.

Results

Humidified CPAP significantly increased TEWL (P<0.001) and skin humidity (P<0.02) compared to non-humidified CPAP. There were no significant differences in skin hydration, skin pH, skin temperature and cytokine expression between both conditions. However, there was a trend of increased median ratios of IL-1a concentrations in the humidified CPAP. There was a significant increase in the interface pressure at the nose bridge after CPAP application (P< 0.02), with higher interface pressure values at the nose bridge comparing with both left (P<0.002) and right (P<0.003) cheeks. The participants reported elevated nasal discomfort during non-humidified CPAP.

Conclusion

These findings indicate that NIV with humidification has a potential disrupting effect on the barrier function of facial skin, associated with changes in skin microclimate and function. Further research is required to establish the cause of mask related skin damage, evaluating the effects of mask design, application techniques and airflow/humidity settings.

More information

Identifiers

ORCID for Peter Worsley: orcid.org/0000-0003-0145-5042

ORCID for David Voegeli: orcid.org/0000-0003-3457-7177

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