title: Treatment-related risk factors for development of skin breakdown in subjects with acute respiratory failure undergoing noninvasive ventilation or CPAP.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) has been recognized as an effective strategy in preventing endotracheal intubation in subjects with acute respiratory failure (ARF). Some interface-related complications have also been recognized, such as skin breakdown (SB). The aim of this study was to determine the frequency of SB and identify potential treatment-related risk factors for its development in adults with ARF undergoing NIV or CPAP.
  
  
  METHODS
  A cross-sectional study was conducted in a general hospital. Subjects were retrospectively enrolled in this study if they were > 18 y old and developed ARF caused by any condition in which NIV or CPAP was indicated for at least one application for a period longer than 2 h. The outcomes were the prevalence of SB and the evaluation of related risk factors. Data were extracted from the electronic medical records. A stepwise forward logistic regression model was used to identify independent risk factors for SB development.
  
  
  RESULTS
  A total of 375 subjects (160 males) met the inclusion criteria and were enrolled in the study. Fifty-four subjects (14.4%) developed SB. The mean number of applications of NIV or CPAP carried out for > 2 h was higher in subjects with SB (7.1 ± 13.3 h) than in those without SB (4.4 ± 13.3 h) (P = .03). Subjects with SB also presented a higher total duration of NIV use (44.6 ± 118.5 h) compared with subjects without SB (21.8 ± 45.5 h) (P = .01). Subjects who developed SB presented a higher use of oronasal mask (92.6%) compared with the group that did not (21.5%) (P < .001).
  
  
  CONCLUSIONS
  In patients with ARF undergoing NIV or CPAP, oronasal mask use for > 26 h was independently associated with development of SB.
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil. wellington.psyamaguti@hsl.org.br wellpsy@yahoo.com.br.
authors.forename: Wellington P
authors.initials: WP
authors.lastname: Yamaguti
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Eliana V
authors.initials: EV
authors.lastname: Moderno
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Yamashita
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Thelma Gmc
authors.initials: TG
authors.lastname: Gomes
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Ana Lígia V
authors.initials: AL
authors.lastname: Maida
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Kondo
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Isabel Cd
authors.initials: IC
authors.lastname: de Salles
authors.affiliation: Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Christina Mm
authors.initials: CM
authors.lastname: de Brito
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005145:Face; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012871:Skin Diseases / Q000209:etiology*; D013997:Time Factors
keywords: acute respiratory failure; noninvasive ventilation; oronasal mask; pressure ulcer; skin breakdown; total face mask; wrap therapy