Advertisement

Intensive Care Medicine

, Volume 31, Issue 7, pp 965–969 | Cite as

Facial side effects during noninvasive positive pressure ventilation in children

  • Brigitte Fauroux
  • Jean-François Lavis
  • Frédéric Nicot
  • Arnaud Picard
  • Pierre-Yves Boelle
  • Annick Clément
  • Marie-Paule Vazquez
Pediatric Original

Abstract

Objective

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

Patients with obstructive sleep apnea (n=16), neuromuscular disorders (n=14), and cystic fibrosis (n=10).

Interventions

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).

Conclusions

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.

Keywords

Nasal mask Noninvasive positive pressure ventilation Child Facial deformity Facial hypoplasia Skin injury 

Notes

Acknowledgements

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.

References

  1. 1.
    Villa MP, Dotta A, Castello D, Piro S, Pagani J, Palamides S, Ronchetti R (1997) Bi-level positive airway pressure (BiPAP) ventilation in an infant with central hypoventilation syndrome. Pediatr Pulmonol 24:66–69CrossRefPubMedGoogle Scholar
  2. 2.
    Li KK, Riley RW, Guilleminault C (2000) An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia. Chest 117:916–918CrossRefPubMedGoogle Scholar
  3. 3.
    Villa MP, Pagani J, Ambrosio R, Ronchetti R, Bernkopf E (2002) Mid-face hypoplasia after long-term nasal ventilation. Am J Respir Crit Care Med 166:1142–1143PubMedGoogle Scholar
  4. 4.
    Anonymous (1998) Management of pediatric patients requiring long-term ventilation. Chest 113:322S–336SGoogle Scholar
  5. 5.
    Anonymous (1999) Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation—a consensus conference report. Chest 116:521–534CrossRefPubMedGoogle Scholar
  6. 6.
    Rutgers M, Lucassen H, Kesteren RV, Leger P (1996) Respiratory insufficiency and ventilatory support. 39th European Neuromuscular Centre International workshop. Neuromuscul Disord 6:431–435CrossRefPubMedGoogle Scholar
  7. 7.
    Fauroux B, Pigeot J, Isabey D, Harf A, Clément A, Lofaso F (2001) In vivo physiological comparison of two ventilators used for domiciliary ventilation in children with cystic fibrosis. Crit Care Med 29:2097–2105CrossRefPubMedGoogle Scholar
  8. 8.
    Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children. Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878PubMedGoogle Scholar
  9. 9.
    Guilleminault C, Pelayo R, Clerk A, Leger D, Bocian RC (1995) Home nasal continuous positive airway pressure in infants with sleep-disordered breathing. J Pediatr 127:905–912PubMedGoogle Scholar
  10. 10.
    Guilleminault C, Philip P, Robinson A (1998) Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease. J Neurol Neurosurg Psychiatry 65:225–232Google Scholar
  11. 11.
    Waters WA, Everett FM, Bruderer JW, Sullivan CE (1995) Obstructive sleep apnea: the use of nasal CPAP in 80 children. Am J Respir Crit Care Med 152:780–785PubMedGoogle Scholar
  12. 12.
    Simonds AK, Ward S, Heather S, Bush A, Muntoni F (2000) Outcome of paediatric domiciliary mask ventilation in neuromuscular and skeletal disease. Eur Respir J 16:476–481CrossRefPubMedGoogle Scholar
  13. 13.
    National Pressure Ulcer Advisory Panel (1989) Pressure ulcers prevalence, cost and risk assessment: consensus development conference statement. Decubitus 2:24–28Google Scholar
  14. 14.
    Reid J, Morrison M (1994) Towards a consensus: classification of pressure sores. J Wound Care 3:157–160Google Scholar
  15. 15.
    Freihofer HP, Bjork G, Jonsson E, Kuijpers-Jagtman AM (1994) Timing of facial osteotomies. A consensus conference. Oral Surg Oral Med Oral Pathol 78:432–436PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Brigitte Fauroux
    • 1
    • 2
  • Jean-François Lavis
    • 3
  • Frédéric Nicot
    • 2
  • Arnaud Picard
    • 3
  • Pierre-Yves Boelle
    • 4
  • Annick Clément
    • 1
    • 2
  • Marie-Paule Vazquez
    • 3
  1. 1.Pediatric Pulmonary Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de ParisUniversity Paris 6ParisFrance
  2. 2.Inserm U 719, Armand Trousseau Hospital, Assistance Publique Hôpitaux de ParisUniversity Paris 6ParisFrance
  3. 3.Maxillofacial Surgery Department and University Research Unit EA 3497, Armand Trousseau Hospital, Assistance Publique Hôpitaux de ParisUniversity Paris 6ParisFrance
  4. 4.Department of Biostatistic, Inserm U444Saint Antoine Hospital, Assistance Publique Hôpitaux de ParisParisFrance

Personalised recommendations