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Facial side effects during noninvasive positive pressure ventilation in children

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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.

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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.

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Corresponding author

Correspondence to Brigitte Fauroux.

Additional information

This study was supported by Assistance Publique-Hôpitaux de Paris, Inserm, Pierre et Marie Curie University (Paris 6); F.N. was supported by Vaincre la Mucoviscidose

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Fauroux, B., Lavis, JF., Nicot, F. et al. Facial side effects during noninvasive positive pressure ventilation in children. Intensive Care Med 31, 965–969 (2005). https://doi.org/10.1007/s00134-005-2669-2

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  • DOI: https://doi.org/10.1007/s00134-005-2669-2

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