Introduction NIV applied via full face masks is increasingly becoming the standard of care in the treatment of acute hypercapnic respiratory failure. Most guidelines suggest good skin care: strategies include regular pressure relief, use of masks with softer cushions/pressure-avoidance masks and application of pressure-relieving dressing to the skin to redistribute pressure and reduce friction. We set out to examine the effect of a systematic proactive prevention approach to prevent Grade 2 Pressure ulcers in a Ward Based Physiotherapy-led acute NIV service in a general hospital serving a population of about 400000. This included (a) prophylactic protective dressing and (b) reactive change to a pressure-avoidance mask for identified Grade 1 pressure sore.
Methods Data was collected from 01/05/2014 and 31/08/2015 which included an 8-month period before (period1) and an 8-month period after (period2) introduction of the proactive prevention approach. Five main sets of data were collected; the NIV mask used (model and size), whether the mask was changed, the total number of days using NIV, pressure ulcer grading and the outcome of the NIV admission. A pressure ulcer was defined as Grade 2 or above.
Results Grade 2 Pressure ulcer rates showed a trend in reduction by over 50% following the change in practice (but fell short of statistical significance: chi-squared test p-value = 0.3). In period1 there were 11 Grade 2 pressure ulcers from 109 admissions; in period2 there were 5 pressure ulcers from 105 admissions. Benefits of using total face masks for NIV delivery were also noted with those patients who were poorly complaint with the standard NIV full face mask to prevent treatment failure.
Conclusions An early prophylactic pressure-relieving dressing and a reactive change to a pressure-avoidance mask for identified Grade 1 pressure sore, can reduce the chance of developing Grade 2 pressure ulcers for patients using NIV acutely. Further studies including longitudinal data on a proactive prevention approach adjusted for acute NIV duration for NIV-related nasal bridge pressure ulceration are needed to confirm the utility of this approach.
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