[The clinical use of an individually fitted nasal mask ("Freiburg Respiratory Mask") within the scope of a case report of controlled BiPAP ventilation].
OBJECTIVE
Noninvasive mechanical ventilation with nasal or face mask using either BiPAP or IPPV (intermittent positive pressure ventilation) modes is meanwhile the standard type of mechanical ventilation instead of endotracheal intubation or tracheostomy in many patients with chronic and acute respiratory failure. However, problems occur very often in noninvasive mechanical ventilation due to mask problems with leakage of air out of the mask or erasions and necrosis of the skin by constant pressure through the mask frame. Hence, some clinical work groups developed customized molded masks mostly in cooperation with dentistry labs. These masks, however, are often very expensive and take several weeks to be manufactured. Our aim was to develop an inexpensive (less than 600 USS) and easy-(in one day)-to-produce customized nasal mask, the so-called "Freiburg nasal mask". We wish to show by a case report the clinical efficacy of this customized mask in severe respiratory failure.


METHODS
A 52 y old women (BMI 19, nonsmoker) suffering from a severe hypercapnic respiratory failure (PCO2 over 100 mmHg) due to a severe kyphoscoliosis as result of a postpoliosyndrome and already on controlled nasal BiPAP with a standard respironics nasal mask, was referred to our clinic as an emergency case. After not succeeding to normalise blood gases and clinical status of the patient in mechanical ventilation on BiPAP mode and additional 2 lit/min of oxygen insufflation via the mask (patient was refusing invasive ventilation) for 12 days due to mask leakage and mask discomfort we made a mould of the patients face. Using this mould in a vacuum process the two EVA polymers Erkoflex and Erkodent were combined to build up the customized mask over the mould on the same day. In the first three days using the customized mask in the patient PCO2 decreased below 70 mmHg, on the 8th day after starting with the customized mask, blood gases almost normalised. Patient compliance in using the BiPAP device increased from 8 h a day to 16 h a day.


CONCLUSIONS
This case shows that sometimes due to leakage of air in standard nasal masks noninvasive mechanical ventilation may fail in patients with severe respiratory failure. Therefore, in these patients customized moulded nasal or face masks should be used instead of standard masks. We think that the Freiburg nasal mask is an example of an easy to produce and nonexpensive customized mask and may be used in such patients, as this case report shows.
Netzer
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Abteilung Pneumologie, Medizinische Universitätsklinik Freiburg.
Sorichter
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S
Bösch
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Werner
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P
Lehmann
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M
D004867:Equipment Design; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation; D008397:Masks; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D016262:Postpoliomyelitis Syndrome / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy*
D010100:Oxygen