Noninvasive positive pressure ventilation: testing the bridge

Comparative evaluation of three total full-face masks for delivering Non-Invasive Positive Pressure Ventilation (NPPV): a bench study

Historically, the oro-nasal mask has been the preferred interface to deliver Non-Invasive Positive Pressure Ventilation (NPPV) in critically ill patients. To overcome the problems related to air leaks and discomfort, Total Full-face masks have been designed. No study has comparatively evaluated the performance of the total Full-face masks available.The aim of this bench study was to evaluate the influence of three largely diffuse models of total Full -face masks on patient-ventilator synchrony and performance during pressure support ventilation. NPPV was applied to a mannequin, connected to an active test lung through three largely diffuse Full-face masks: Dimar Full-face mask (DFFM), Performax Full-face mask (RFFM) and Pulmodyne Full-face mask (PFFM).The performance analysis showed that the ΔPtrigger was significantly lower with PFFM (p < 0.05) at 20 breaths/min (RRsim) at both pressure support (iPS) levels applied, while, at RRsim 30, DFFM had the longest ΔPtrigger compared to the other 2 total full face masks (p < 0.05). At all ventilator settings, the PTP200 was significantly shorter with DFFM than with the other two total full-face masks (p < 0.05). In terms of PTP500 ideal index (%), we did not observe significant differences between the interfaces tested.The PFFM demonstrated the best performance and synchrony at low respiratory rates, but when the respiratory rate increased, no difference between all tested total full-face masks was reported.

Comparison of Comfort and Effectiveness of Total Face Mask and Oronasal Mask in Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure: A Clinical Trial

Background. There is a growing controversy about the use of oronasal masks (ONM) or total facemask (TFM) in noninvasive positive pressure ventilation (NPPV), so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods. Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t-test and chi-square test. Repeated measures ANOVA and Mann-Whitney U test were used to compare clinical and laboratory data. Results. There were no differences in venous blood gas (VBG) values between the two groups (P > 0.05). However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2) (P = 0.04). Patient comfort and acceptance were statistically similar in both groups (P > 0.05). Total time of NPPV was also similar in the two groups (P > 0.05). Conclusions. TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase.

The total face mask is more comfortable than the oronasal mask in noninvasive ventilation but is not associated with improved outcome

BACKGROUND

Noninvasive positive-pressure ventilation (NPPV) is commonly used to improve ventilation and oxygenation and avoid endotracheal intubation and mechanical ventilation. Although clinically indicated, most patients fail to use NPPV due to mask intolerance. A total face mask was designed to increase compliance, but whether this translates into better outcome (improvement in clinical and blood gas parameters and less intubation) is unknown.

OBJECTIVES

We compared the evolution of the clinical parameters, blood gases, levels of ventilatory support and rate of endotracheal intubation using the total face mask or the traditional oronasal mask during NPPV.

METHODS

A total of 60 patients were randomized to use either mask during NPPV. The clinical and laboratory parameters, as well as the level of ventilatory support were recorded at different intervals in both groups for up to 6 h. In addition, the tolerance for each mask and the need for endotracheal intubation were compared.

RESULTS

Patients tolerated the total face mask significantly better (p = 0.0010) and used NPPV for a longer time (p = 0.0017) when compared with the oronasal mask. Just 1 patient switched to the total face mask because of intolerance. Although better tolerated, the rate of endotracheal intubation was similar in both groups (p = 0.4376), as was the clinical and laboratory evolution.

CONCLUSIONS

The total face mask was more comfortable, allowing the patients to tolerate NPPV longer; however, these accomplishments did not translate into a better outcome. Due to its comfort, the total face mask should be available, at least as an option, in units where NPPVs are routinely applied.