Efficacy of a New Full Face Mask for Noninvasive Positive Pressure Ventilation

doi:10.1378/chest.106.4.1109

Chest

Volume 106, Issue 4, October 1994, Pages 1109-1115

https://doi.org/10.1378/chest.106.4.1109 Get rights and content

Previous studies have shown that noninvasive positive pressure ventilation (NPPV) improves gas exchange in acute and chronic respiratory failure. However, some patients are unable to tolerate NPPV due to air leaks around the mask, facial discomfort, and claustrophobia. A new mask that covers the entire face (Total, Respironics, Monroeville, Pa), attempts to overcome these obstacles. We studied the efficacy of NPPV via the Total face mask (TFM) in nine patients with chronic respiratory failure. In three patients, respiratory failure was due to chronic obstructive lung disease, and in six patients, it was secondary to restrictive disorders. None of the patients were previously able to tolerate NPPV via nasal (N) or nasal-oral (NO) masks. At baseline, all patients had impaired gas exchange with low PaO₂/FIo₂ (241±14), elevated PaCO₂ (79±5 mm Hg), and poor functional status (1.89±1.45, on a scale of 1 to 7). After NPPV in the hospital for 7.1±1.5 h per night for 22±26 days, the PaCO₂ fell to 59±3 mm Hg, and the PaO₂/FIo₂ rose to 304±27. Following nocturnal NPPV via the TFM for 6.7±1.5 h a night 6±5 weeks after hospital discharge, sustained improvements in PaCO₂ (58±3 mm Hg, p<0.05), PaO₂/FIo₂ (304±18), and functional status (5.38±1.06, p<0.05) were observed. In four patients, measurements of respiratory rate, tidal volume, minute ventilation, dyspnea, discomfort with the face mask, and mask and mouth leaks were made during 30-min sessions of NPPV applied at constant levels via all three masks (N, NO, TFM). Discomfort with the face mask (0.38±0.18 vs 1.44±0.34 vs 2.38±0.32, p<0.05) and mask leaks (0.44±0.18 vs 1.89±0.39 vs 1.89±0.35, p<0.05) were least during NPPV via TFM compared with the N or NO masks, respectively. Moreover, expired tidal volume was highest (804±10 vs 498±9 vs 537±13 ml, p<0.05) and PaCO₂ lowest (51±2 vs 57±2 vs 58±3, p<0.05) during NPPV via the TFM compared with N or NO masks. We conclude that NPPV delivered via a Total mask ensures a comfortable, stable patient-mask interface and improves gas exchange in selected patients intolerant of more conventional N or NO masks.

Section snippets

Patient Selection

All patients were admitted to the Ventilator Rehabilitation Unit at Temple University Hospital, Philadelphia, for evaluation and treatment of chronic respiratory failure. This noninvasive respiratory care unit evaluates patients for noninvasive mechanical ventilation, instructs patients in the use of respiratory equipment, provides whole body and respiratory muscle reconditioning, and coordinates continuing outpatient follow-up.
Prior to admission all patients were maximally treated with

Results

Patient characteristics are shown in Table 2. Three patients had severe obstructive lung disease, and six patients had severe restrictive disorders. The patients’ ages ranged from 44 to 81 years. Three of the nine patients suffered from acute superimposed on chronic respiratory failure that had necessitated recent (within 6 months of the study) endotracheal intubation and mechanical ventilation. The remaining patients had a more gradual, progressive worsening of their respiratory status. Five

Discussion

There was a significant improvement in gas exchange short term during NPPV with all three masks; however, the reduction in PaCO₂ was greatest when NPPV was delivered with the TFM. This is attributed to the observation that the increases in expired tidal volume and minute ventilation were greatest with the use of the total face mask. In addition, dyspnea, discomfort with the face mask, and level of mask or mouth leaks were least during NPPV with the TFM compared with the N or NO masks. Moreover,

ACKNOWLEDGEMENTS

We would like to acknowledge the donation of the Total masks used during this study by Respironics, and the secretarial assistance of Darlene Macon.

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The influence of changing interfaces on aerosol delivery within high flow oxygen setting in adults: An in-vitro study: Impact of interface changing on aerosol in high flow oxygen setting
2020, Journal of Drug Delivery Science and Technology
Citation Excerpt :
On the other hand, the dead space volume of the oronasal mask is greater than that of a nasal cannula or that of the mouthpiece which may suggest some aerosol saving while exhaling than nasal cannula of the lowest dead volume. The length of the cannulae had the main contribution over the interface's dead space volume encouraging aerosol condensation [8,32]. The previous explanation is only applicable at low gas flows but at high flows, neither the dead space nor the diameter exerts an obvious effect on aerosol delivery as the largest portion of aerosol impacted in the heater-humidifier itself and within the circuit before reaching the interface [22].
Despite the fact that the nasal-cannula is more comfortable than facemask, using facemask with high flow oxygen therapy (HFOT) may be beneficial in mouth-breathers. The aim of the present work was to evaluate aerosol-delivery both between different interfaces and flows using HFOT setting.
The experiment was conducted using an Aerogen-Solo vibrating mesh nebulizer connected proximally to the humidifier in HFOT circuit using three different interfaces (nasal-cannula, mouthpiece, and valved-facemask) at 10, 20 and 30 L/min oxygen-flows. The amount of drug deposited on each part was quantified using HPLC.
Total inhalable dose using facemask and mouthpiece (15.3% and 13.7% of nominal-dose, respectively) was significantly higher (p < 0.001) than that delivered by nasal-cannula (6.5% of nominal-dose) at oxygen-flow 10 L/min. Aerosol-delivery was decreased with increasing oxygen-flow regardless of the interface used. Aerosol-deposition within the interface increased significantly with increasing gas flow in nasal-cannula only. The mean inhaled-dose delivered without oxygen was 11.1, 7.4 and 1.3% of nominal-dose by valved-facemask, mouthpiece and nasal-cannula, respectively. Aerosol-deposition in the tubing of nasal-cannula only was significantly (p < 0.001) increased when aerosol nebulization was not combined with oxygen-delivery (88.0% of nominal-dose).
Valved-facemask or mouthpiece can serve as an acceptable option in mouth-breathers for HFOT combined with aerosol-delivery. Increasing gas-flow decreased dose-delivered.
Noninvasive Options
2018, Critical Care Clinics
Citation Excerpt :
NIV interfaces behave differently in respect to CO2 exchange. The face mask constitutes an additional mechanical dead space, and its effect on CO2 rebreathing is proportional to its internal volume.12 Because this volume is small compared with a patient’s tidal volume, the amount of CO2 that is rebreathed is also small.
Comparison of three continuous positive airway pressure (CPAP) interfaces in healthy Beagle dogs during medetomidine–propofol constant rate infusions
2018, Veterinary Anaesthesia and Analgesia
Citation Excerpt :
However, a perfect seal also introduces a higher risk for rebreathing because a lower flow from the CPAP machine can maintain the pressure but the flow may be too low to wash out expired CO2 from the relatively large equipment dead space. This could explain why a higher PaCO2 (0.53 kPa, 4 mmHg) was observed with FM during CPAP-delivery (Criner et al. 1994; Taccone et al. 2004) as almost no leak was observed with this treatment. Unfortunately, PICO2 was not measured during CPAP-delivery.
To compare the efficacy of three continuous positive airway pressure (CPAP) interfaces in dogs on gas exchange, lung volumes, amount of leak during CPAP and rebreathing in case of equipment failure or disconnection.
Randomized, prospective, crossover, experimental trial.
Ten purpose-bred Beagle dogs.
Dogs were in dorsal recumbency during medetomidine–propofol constant rate infusions, breathing room air. Three interfaces were tested in each dog in a consecutive random order: custom-made mask (M), conical face mask (FM) and helmet (H). End-expiratory lung impedance (EELI) measured by electrical impedance tomography was assessed with no interface (baseline), with the interface only (No-CPAP for 3 minutes) and at 15 minutes of 7 cmH₂O CPAP (CPAP-delivery). PaO₂ was assessed at No-CPAP and CPAP-delivery, partial pressure of inspired carbon dioxide (PICO₂; rebreathing assessment) at No-CPAP and the interface leak (ΔP_leak) at CPAP-delivery. Mixed-effects linear regression models were used for statistical analysis (p < 0.05).
During CPAP-delivery, all interfaces increased EELI by 7% (p < 0.001). Higher ΔP_leak was observed with M and H (9 cmH₂O) in comparison with FM (1 cmH₂O) (p < 0.001). At No-CPAP, less rebreathing occurred with M (0.5 kPa, 4 mmHg) than with FM (1.8 kPa, 14 mmHg) and with H (1.4 kPa, 11 mmHg), but also lower PaO₂ was measured with M (9.3 kPa, 70 mmHg) than with H (11.9 kPa, 90 mmHg) and FM (10.8 kPa, 81 mmHg).
All three interfaces can be used to provide adequate CPAP in dogs. The leak during CPAP-delivery and the risk of rebreathing and hypoxaemia, when CPAP is not maintained, can be significant. Therefore, animals should always be supervised during administration of CPAP with any of the three interfaces. The performance of the custom-made M was not superior to the other interfaces.
Interfaces for noninvasive ventilation in the acute setting in children
2017, Paediatric Respiratory Reviews
Citation Excerpt :
Because mask-fit pressure is spread over a larger surface beyond the nose area, total face masks may be more comfortable than oronasal masks [28] (Table 1). In adults, the total face mask has shown to be as efficient as an oronasal mask in terms of breathing pattern, gas exchange and outcome [28–30]. However, a total face mask has a larger internal volume and therefore a larger anatomical dead space which may interfere with the efficacy of NIV [31].
The use of noninvasive ventilation (NIV) is very specific in the acute setting as compared to its use in a chronic setting. In the Pediatric Intensive care Unit (PICU), NIV may be required around the clock and initiation has to be fast and easy. Despite the increasing use of non-invasive ventilation (NIV) and the larger choice of interfaces, data comparing the use of different interfaces for pediatric patients are scarce and recommendations for the most appropriate choice of interface are lacking. However, this choice in acute settings is crucial and a major contributor of the success of NIV. The aim of the present review was to describe the different types of interfaces available for children in the acute setting, their advantages and limitations, to highlight how to choose the optimal interface, and how to monitor the tolerance of the interface.
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Clinical Investigations: Mask VentilationEfficacy of a New Full Face Mask for Noninvasive Positive Pressure Ventilation

Section snippets

Patient Selection

Results

Discussion

ACKNOWLEDGEMENTS

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Mayo Clin Proc

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Nocturnal positive pressure via nasal mask

Am Rev Respir Dis

Clinical Investigations: Mask Ventilation
Efficacy of a New Full Face Mask for Noninvasive Positive Pressure Ventilation