title: Facial side effects during noninvasive positive pressure ventilation in children.
abstract: 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.
authors.affiliation: 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
authors.forename: Brigitte
authors.initials: B
authors.lastname: Fauroux
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Lavis
authors.forename: Frédéric
authors.initials: F
authors.lastname: Nicot
authors.forename: Arnaud
authors.initials: A
authors.lastname: Picard
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boelle
authors.forename: Annick
authors.initials: A
authors.lastname: Clément
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Vazquez
mesh_terms: 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*