Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. A total face mask, which has no contact with the more sensitive areas of the face, is a possible option. We describe 3 patients with acute respiratory failure due to amyotrophic lateral sclerosis, who developed nasal bridge skin necrosis during continuous NIV, and one patient with post-extubation respiratory failure due to a high spinal cord injury, who had facial trauma with contraindication for conventional mask use. The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode.
WoodKA, LewisL, Von HarzB, KollefMH. The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial. Chest, 1998; 113(5):1339–1346.
2.
ContiG, CavaliereF, CostaR, CrabaA, CatarciS, FestaV, et al. Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study. Respir Care, 2007; 52(11):1463–1471.
3.
GregorettiC, ConfalonieriM, NavalesiP, SquadroneV, FrigerioP, BeltrameF, et al. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study. Intensive Care Med, 2002; 28(3):278–284.
4.
MehtaS, HillNS. Noninvasive ventilation. Am J Respir Crit Care Med, 2001; 163(2):540–577.
5.
ElliottMW. The interface: crucial for successful noninvasive ventilation. Eur Respir J, 2004; 23(1):7–8.
6.
NavaS, NavalesiP, GregorettiC. Interfaces and humidification for noninvasive mechanical ventilation. Respir Care, 2009; 54(1):71–84.
7.
British Thoracic Society Standards of Care Committee. Non-invasive ventilation in acute respiratory failure. Thorax, 2002; 57(3):192–211.
8.
CrinerGJ, TravalineJM, BrennanKJ, KreimerDT. Efficacy of a new full face mask for noninvasive positive pressure ventilation. Chest, 1994; 106(4):1109–1115.
9.
RoyB, CordovaFC, TravalineJM, D'AlonzoGEJr, CrinerGJ. Full face mask for noninvasive positive-pressure ventilation in patients with acute respiratory failure. J Am Osteopath Assoc, 2007; 107(4):148–156.
10.
AntonelliM, ContiG, PelosiP, GregorettiC, PennisiMA, CostaR, et al. New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet - a pilot controlled trial. Crit Care Med, 2002; 30(3):602–608.
11.
ChiumelloD, PelosiP, CarlessoE, SevergniniP, AspesiM, GamberoniC, et al. Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask. Intensive Care Med, 2003; 29(10):1671–1679.
12.
RaccaF, AppendiniL, BertaG, BarberisL, VittoneF, GregorettiC, et al. Helmet ventilation for acute respiratory failure and nasal skin breakdown in neuromuscular disorders. Anesth Analg, 2009; 109(1):164–167.
13.
RaccaF, AppendiniL, GregorettiC, StraE, PatessioA, DonnerCF, et al. Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. J Appl Physiol, 2005; 99(4):1262–1271.
14.
NavalesiP, CostaR, CerianaP, CarlucciA, PrinianakisG, AntonelliM, et al. Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask. Intensive Care Med, 2007; 33(1):74–81.
15.
BachJR, BianchiC, AufieroE. Oximetry and indications for tracheotomy for amyotrophic lateral sclerosis. Chest, 2004; 126(5):1502–1507.
16.
KangSW, BachJR. Maximum insufflation capacity. Chest, 2000; 118(1):61–65.
17.
BachJR, GoncalvesMR, PaezS, WinckJC, LeitaoS, AbreuP. Expiratory flow maneuvers in patients with neuromuscular diseases. Am J Phys Med Rehabil, 2006; 85(2):105–111.
18.
SanchoJ, ServeraE, MarinJ, VergaraP, BeldaFJ, BachJR. Effect of lung mechanics on mechanically assisted flows and volumes. Am J Phys Med Rehabil, 2004; 83(9):698–703.
19.
WinckJC, GoncalvesMR, LourencoC, VianaP, AlmeidaJ, BachJR. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest, 2004; 126(3):774–780.
20.
BachJR, GoncalvesMR, HamdaniI, WinckJC. Extubation of patients with neuromuscular weakness: a new management paradigm. Chest, 2010; 137(5):1033–1039.
21.
MeduriGU, TurnerRE, Abou-ShalaN, WunderinkR, TolleyE. Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest, 1996; 109(1):179–193.
22.
FerrerM, EsquinasA, ArancibiaF, BauerTT, GonzalezG, CarrilloA, et al. Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med, 2003; 168(1):70–76.
23.
BradleyMD, OrrellRW, ClarkeJ, DavidsonAC, WilliamsAJ, KullmannDM, et al. Outcome of ventilatory support for acute respiratory failure in motor neurone disease. J Neurol Neurosurg Psychiatry, 2002; 72(6):752–756.
24.
SanchoJ, ServeraE, DiazJ, MarinJ. Efficacy of mechanical insufflation-exsufflation in medically stable patients with amyotrophic lateral sclerosis. Chest, 2004; 125(4):1400–1405.
25.
SenentC, GolmardJL, SalachasF, ChinerE, Morelot-PanziniC, MeningerV, et al. A comparison of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis. Amyotroph Lateral Scler, 2011; 12(1):26–32.
26.
HarropJS, SharanAD, ScheidEHJr, VaccaroAR, PrzybylskiGJ. Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A. J Neurosurg, 2004; 100(1 Suppl Spine):20–23.
