title: Facial skin breakdown in patients with non-invasive ventilation devices: report of two cases and indications for treatment and prevention.
abstract: Non-invasive ventilation (NIV) provides an effective ventilatory support in patients with respiratory failure without endotracheal intubation. However, there are potential problems with its clinical application and the development of pressure ulcers represents a common complication. Often several intensive care units treat facial skin breakdown related to NIV. In this article, we report our experience in treatment and prevention of these lesions, emphasising the higher risk of certain age groups to develop them, such as preterm infants and elderly patients with comorbidities. We performed daily disinfection of the lesions followed by application of topical cream containing hyaluronic acid (HA) sodium salt. In addition, in order to prevent worsening of injury, we applied a cushion made of gauze pad containing HA sodium salt between the skin and the masks, so as to reduce friction between the NIV devices and the skin. Local medical treatment allowed complete reepithelialisation of the injured skin areas. Systematic monitoring of patients' faces is essential to detect early damages and to intervene with appropriate therapy, especially in preterm infants and elderly. Moreover, refining the devices with the proposed protective cushion can reduce pressure ulcers and increase comfort for the patients.
authors.affiliation: Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Maruccia
authors.affiliation: Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Ruggieri
authors.affiliation: Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Onesti
mesh_terms: D000367:Age Factors; D000368:Aged; D005151:Facial Injuries / Q000188:drug therapy* / Q000209:etiology*; D017276:Friction; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008397:Masks / Q000009:adverse effects*; D009336:Necrosis / Q000517:prevention & control; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D003668:Pressure Ulcer / Q000188:drug therapy* / Q000209:etiology*; D011482:Protective Devices; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006820:Hyaluronic Acid
keywords: Face mask; Hyaluronic acid; Non-invasive ventilation; Pressure ulcers; Skin necrosis