Mask Interface: Leaks
Mask Interfaces for Noninvasive Mechanical Ventilation: Principles of Technology and Clinical Practice, NOVA Publications , ss.197-204, 2022
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2022
- Yayınevi: NOVA Publications
- Sayfa Sayıları: ss.197-204
- Anahtar Kelimeler: intentional leaks, interface, nonintentional leaks, noninvasive positive-pressure ventilation, patient-ventilator asynchrony
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
The most common mask-related side effect of noninvasive positive-pressure ventilation (NPPV) is leakage which can interfere with treatment efficacy. Leak-related side effects including mouth dryness and nose congestion are associated with poor adherence. Patientreported leaks are not always correlated with device-reported data. The severity of the leaks depends on the perception of the patients that can be evaluated by questionnaires. The perception of the leak can be affected by the strength of the leak-flow, noise, sensitivity of the patients’ skin and eyes, social and ethnic factors. The measurement and reporting of leaks by NPPV devices remain non-standardized. Patient-reported leaks are correlated with non-adherence. The factors causing higher leaks include older age, higher body-mass index, male gender, central fat distribution, oronasal mask, and nasal obstruction. The first step to reduce leaks is to understand the underlying mechanism and type of the leak. While intentional leaks are necessary to avoid rebreathing, nonintentional leaks due to unfit masks, unsealed tubes, or mouth opening are regarded as the major cause of many adverse effects of NPPV. Patient-ventilator asynchrony stands as an important issue related to the large leaks as well. The amount of leak requiring interventions is also controversial. Chinstraps or heated humidification can be used to reduce mouth leaks. Switching between interface types is also an option. However, palatal prolapsus may cause unintentional leaks in which these interventions may fail due to the closed mouth. Besides, auto-triggering and delays in cycling due to large leaks during NPPV can be solved by optimizing the device settings. New technologies including telemedicine, 3D printing of customized masks, and new modalities of NPPV treatment may improve the management of the leak and treatment efficacy consequently.