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

The effect of humidified noninvasive ventilation (NIV) on the development of facial skin breakdown
The effect of humidified noninvasive ventilation (NIV) on the development of facial skin breakdown
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.
0020-1324
Alqahtani, Jaber Saud
1b64f1a5-b742-4d95-a605-2493856180ad
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10
Alqahtani, Jaber Saud
1b64f1a5-b742-4d95-a605-2493856180ad
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10

Alqahtani, Jaber Saud, Worsley, Peter and Voegeli, David (2018) The effect of humidified noninvasive ventilation (NIV) on the development of facial skin breakdown. Respiratory Care. (doi:10.4187/respcare.06087).

Record type: Article

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.

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The Effect of Humidified Noninvasive Ventilation (NIV) on the Development of Facial Skin Breakdown - Accepted Manuscript
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More information

Accepted/In Press date: 11 February 2018
e-pub ahead of print date: 28 August 2018

Identifiers

Local EPrints ID: 424776
URI: http://eprints.soton.ac.uk/id/eprint/424776
ISSN: 0020-1324
PURE UUID: 49824e56-ade8-4d16-8f78-a3e860dd96aa
ORCID for Peter Worsley: ORCID iD orcid.org/0000-0003-0145-5042
ORCID for David Voegeli: ORCID iD orcid.org/0000-0003-3457-7177

Catalogue record

Date deposited: 05 Oct 2018 11:45
Last modified: 17 Dec 2019 01:43

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