Facial side effects during noninvasive positive pressure ventilation in children.
OBJECTIVE
The study quantified the side effects of nasal masks use for noninvasive positive pressure ventilation (NPPV) in children.


METHODS
Cross-sectional retrospective study in a tertiary pediatric university hospital.


METHODS
Patients with obstructive sleep apnea (n=16), neuromuscular disorders (n=14), and cystic fibrosis (n=10).


METHODS
Clinical evaluation of facial tolerance.


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.
Fauroux
Brigitte
B
Pediatric Pulmonary Department, Armand Trousseau Hospital, Assistance Publique Hôpitaux de Paris, University Paris 6, 28 avenue du Docteur Arnold Netter, 75012, Paris, France. brigitte.fauroux@trs.ap-hop-paris.fr
Lavis
Jean-François
JF
Nicot
Frédéric
F
Picard
Arnaud
A
Boelle
Pierre-Yves
PY
Clément
Annick
A
Vazquez
Marie-Paule
MP
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005151:Facial Injuries / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008397:Masks / Q000009:adverse effects*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012189:Retrospective Studies; D012867:Skin / Q000293:injuries*