Chest
Volume 139, Issue 5, May 2011, Pages 1034-1041
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Original Research
Critical Care
Evaluation of the Total Face Mask for Noninvasive Ventilation to Treat Acute Respiratory Failure

https://doi.org/10.1378/chest.10-1905Get rights and content

Background

We hypothesized that the total face mask (TFM) would be perceived as more comfortable than a standard oronasal mask (ONM) by patients receiving noninvasive mechanical ventilation (NIV) therapy for acute respiratory failure (ARF) and would be quicker to apply by respiratory therapists.

Methods

Sixty patients presenting with ARF were randomized to receive NIV via either an ONM or a TFM. Mask comfort and dyspnea were assessed using visual analog scores. Other outcomes included time required to apply, vital signs and gas exchange at set time points, and early NIV discontinuation rates (ie, stoppage while still requiring ventilatory assistance).

Results

Mask comfort and dyspnea scores were similar for both groups through 3 h of use. The time required to apply the mask (5 min [interquartile range (IQR), 2-8] vs 3.5 min [IQR, 1.9-5]), and duration of use (15.7 h [IQR, 4.0-49.8]) vs 6.05 h [IQR, 0.9-56.7]) were not significantly different between the ONM and the TFM group, respectively. Except for heart rate, which was higher at baseline in the TFM group, no differences in vital signs or gas exchange were detected between the groups during the first 3 h (P > .05). Early NIV discontinuation rates were similar for both the ONM group and TFM group (40% vs 57.1%); however, eight patients in the TFM group were switched to an ONM within 3 h, and none from the ONM group was switched to a TFM (P < .05).

Conclusions

Among patients with ARF requiring NIV, the ONM and TFM were perceived to be equally comfortable and had similar application times. Early NIV discontinuation rates, improvements in vital signs and gas exchange, and intubation and mortality rates were also similar.

Section snippets

Performance Sites

The study was performed at Tufts Medical Center, Boston, Massachusetts, and Rhode Island Hospital, Providence, Rhode Island, and was approved by the institutional review boards at each institution (approval numbers 6060 and 0198-01, respectively). At Tufts Medical Center, the study was deemed to add minimal risk, and a consent waiver was granted. Informed consent was obtained from patients or their proxies at Rhode Island Hospital.

Patients

Patients ≥ 18 years old with acute respiratory distress

Baseline Characteristics

Of 66 patients screened for enrollment, six patients were excluded (Fig 4). Baseline characteristics did not differ significantly between the two groups (Table 1), except for a higher heart rate in the TFM group. Patients in the TFM group tended to have more COPD exacerbations and those in the ONM group more pneumonia, but these differences were not statistically significant (Table 2). Three patients in the ONM group and four patients in the TFM group previously received home NIV therapy using

Discussion

The key findings of this study are that the TFM and the ONM (1) are perceived as similarly comfortable by patients with ARF receiving NIV, (2) require similar amounts of time for placement, and (3) are associated with similar early NIV discontinuation rates, although the TFM tends to be associated with intolerance and poor fit more often than does the ONM.

Mask type can be a major factor affecting patient comfort and adherence to therapy during NIV.13, 14, 15, 27, 28, 29 Using a randomized

Conclusions

In summary, our study demonstrates that the TFM does not offer significant advantages over the ONM. espite the trend towards more early discontinuations because of mask intolerance with the TFM than with the ONM, the TFM performed as well as the ONM with regard to other major outcomes, such as avoiding intubation, and mortality, and should be considered a possible alternative when very rapid application is desired or when nasal ulcers or intolerance complicate the use of ONM.

Acknowledgments

Author contributions: Dr Ozsancak: contributed to study design, data acquisition and analysis, and preparation of the manuscript.

Dr Sidhom: contributed to study design, data acquisition and analysis, and preparation of the manuscript.

Dr Liesching: contributed to study design, data acquisition and analysis, and preparation of the manuscript.

Mr Howard: contributed to data acquisition and analysis and preparation of the manuscript.

Dr Hill: contributed to study design, data acquisition and

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    Funding/Support: This study was partially funded by research grants from Respironics, Inc (Dr Hill).

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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