title: Pressure Ulcer Incidence in Patients Wearing Nasal-Oral Versus Full-Face Noninvasive Ventilation Masks.
abstract: BACKGROUND
  Device-related pressure ulcers from noninvasive ventilation masks alter skin integrity and cause patients discomfort.
  
  
  OBJECTIVE
  To examine the incidence, location, and stage of pressure ulcers and patients' comfort with a nasal-oral mask compared with a full-face mask.
  
  
  METHODS
  A before-after study of a convenience sample of patients with noninvasive ventilation orders in 5 intensive care units was conducted. Two groups of 100 patients each received either the nasal-oral mask or the full-face mask. Skin was assessed before the mask was applied and every 12 hours after that or upon mask removal. Comfort levels were assessed every 12 hours on a Likert scale of 1 to 5 (1, most comfortable).
  
  
  RESULTS
  A pressure ulcer developed in 20% of patients in the nasal-oral mask group and 2% of patients in the full-face mask group (P < .001). Comfort scores were significantly lower (more comfortable) with the full-face mask (mean [SD], 1.9 [1.1]) than with the nasal-oral mask (mean [SD], 2.7 [1.2], P < .001). Neither mean hours worn nor percentage adherence differed significantly: 28.9 (SD, 27.2) hours and 92% for full-face mask and 25 (SD, 20.7) and 92% for nasal-oral mask. No patients who had a pressure ulcer develop with the nasal-oral mask had a pressure ulcer develop with the full-face mask.
  
  
  CONCLUSIONS
  The full-face mask resulted in significantly fewer pressure ulcers and was more comfortable for patients. The full-face mask is a reasonable alternative to traditional nasal-oral masks for patients receiving noninvasive ventilation.
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri. mes4143@bjc.org.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Schallom
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cracchiolo
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Falker
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Foster
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Hager
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Tamara
authors.initials: T
authors.lastname: Morehouse
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Peggy
authors.initials: P
authors.lastname: Watts
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Linda
authors.initials: L
authors.lastname: Weems
authors.affiliation: Marilyn Schallom is a clinical nurse specialist and research scientist in the Department of Research, Lisa Cracchiolo and Linda Weems are registered respiratory therapists and supervisors in the Respiratory Care Services Department, Antoinette Falker is a clinical nurse specialist for trauma, acute care surgery, and bariatrics, Jennifer Foster is a nurse educator in the neuroscience intensive care unit, JoAnn Hager is a certified wound/ostomy/continence nurse, Tamara Morehouse is a certified would care nurse with the wound/ostomy/continence team, and Peggy Watts is a registered respiratory therapist and manager in the Respiratory Care Services Department at Barnes-Jewish Hospital, St Louis, Missouri. Marin Kollef is a professor of medicine at Washington University School of Medicine, St Louis, Missouri.
authors.forename: Marin
authors.initials: M
authors.lastname: Kollef
mesh_terms: D015984:Causality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008397:Masks / Q000009:adverse effects*; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000295:instrumentation*; D009666:Nose; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000453:epidemiology*; D012131:Respiratory Insufficiency / Q000628:therapy; D013997:Time Factors