Facial side effects during noninvasive positive pressure ventilation in children
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The study quantified the side effects of nasal masks use for noninvasive positive pressure ventilation (NPPV) in children.
Design and setting
Cross-sectional retrospective study in a tertiary pediatric university hospital.
Patients with obstructive sleep apnea (n=16), neuromuscular disorders (n=14), and cystic fibrosis (n=10).
Clinical evaluation of facial tolerance.
Measurements and results
A skin injury was observed in 19 patients (48%), with a transient erythema in 7 (18%), prolonged erythema in 9 (23%), and skin necrosis in 3 (8%). Skin injury was associated with age over 10 years (OR=16) and use of a commercial mask (OR=15) and was less frequent in patients with obstructive sleep apnea. The change of a commercial mask for a custom-made mask was associated with reduction in the skin injury score. Global facial flattening was present in 68% of the patients. No correlation was observed with age, daily or cumulative use of NPPV, or the type of mask. A maxillary retrusion was present in 37% of patients. No correlation was observed with age or the type of mask or the underlying disease, but an association was found with a longer daily use of NPPV (OR=6.3).
The prevalence of facial side effects is clinically significant in children using NPPV. Systematic maxillofacial follow-up enables these effects to be identified. Remedial measures could include the change of the interface or reducing the daily use of NPPV.
KeywordsNasal mask Noninvasive positive pressure ventilation Child Facial deformity Facial hypoplasia Skin injury
The authors gratefully thank Gérard Accart and Ratib Alzeibak for their exceptional expertise in performing the custom-made masks, Dr. Patrick Diner and Dr. Catherine Tomat for their help and advice in the follow-up of the patients, and Dr. Michael Polkey and Pr. Frédéric Lofaso for their helpful comments.
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