Masks and interfaces

When first starting your NIV program, it is recommended to try some of the many different masks and interfaces available to make the right choice.

 

Up to 50% of NIV failures are related to the mask.¹ That is why interfaces or masks should be considered an important factor for any successful NIV program. There is a wide range of masks available on the market. Especially in the beginning of a NIV program, it is recommended to have a choice of interfaces available in order to gain experience with the different types.

 

Having only one type of masks might pose a risk on the success of the program.² Hess recommends: “For applications of NIV for acute respiratory failure, the first choice of interface should be the oronasal mask. The available evidence suggests that the total face mask might also be a reasonable first choice for interface. Other interfaces should be available if the patient is intolerant of the oronasal mask or total face mask, or if complications such as facial skin breakdown occurs”.³

 

 

Masks designed for resuscitation or anesthesia applications are typically uncomfortable and may promote complications, such as facial skin breakdown.

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Predictors of failure for NIV                                 Adverse effects and remedies

 

  • Discomfort: Check fit, adjust straps, change interface
  • Excessive air leaks: Realign interface, check strap tension, change to full face mask
  • Nasal bridge redness or ulceration: Use artificial skin, minimize strap tension, use spacer, alternate interface
  • Skin irritation or rashes: Use skin barrier lotion and/or topical corticosteroids, change to mask made from a different material, properly clean mask
  • Claustrophobic reactions: Try nasal interface or total face mask, sedate judiciously

Complications of NIV: Airflow/Pressure Related  

Adverse Effects and Remedies

 

  • Nasal congestion: Try nasal steroids, decongestant, antihistamine or humidification
  • Nasal or oral dryness: Add humidification, nasal saline, oral/nasal hygiene or decrease leak
  • Sinus or ear pain: Lower inspiratory pressure
  • Gastric inflation: Avoid excessive inspiratory pressures (over 20 cm H2O), administer Simethicone
  • Eye irritation: Check mask fit, readjust headgear straps
  • Failure to ventilate: Use sufficient pressures, optimize patient-ventilator synchron

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Despite its proven benefits to improve patient comfort and reduce mortality and also costs, noninvasive ventilation (NIV) is still underutilized at many hospitals. This website is designed to promote the usage of NIV by sharing the many situations in which NIV improves patients’ outcomes as well as to inform about the factors which are important in order to perform successful NIV.

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