Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts.
BACKGROUND
In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients.


OBJECTIVE
To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided.


METHODS
Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel.


RESULTS
Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet®hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin.


CONCLUSIONS
The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis.
Universidad de Barcelona, Vicepresidenta SEEIUC, Coordinadora del documento, Barcelona, España. Electronic address: martaraure@gmail.com.
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Raurell-Torredà
Universidad de Girona, Girona, España.
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Romero-Collado
Residencia de Mayores José Matía Calvo, Miembro Comité Director GNEAUPP, Cádiz, España.
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Rodríguez-Palma
Campus Docent Sant Joan de Déu, Presidenta del Comité Científico de Enfermería de la SECIP, Barcelona, España.
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Farrés-Tarafa
Hospital Clínic de Barcelona, Miembro del Comité Científico SEPAR, Barcelona, España.
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Martí
Campus Docent Sant Joan de Déu, Miembro del Comité Científico de la SECIP, Barcelona, España.
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Hurtado-Pardos
Hospital Materno-infantil Sant Joan de Déu, Miembro del Comité Científico de la SECIP, Barcelona, España.
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Peñarrubia-San Florencio
Hospital General Universitario José María Morales Messeguer, Murcia, España.
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Saez-Paredes
Hospital General Universitario José María Morales Messeguer, Presidente Asociación Internacional de Ventilación No Invasiva, Murcia, España.
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Esquinas
D006801:Humans; D063087:Noninvasive Ventilation / Q000295:instrumentation*; D017410:Practice Guidelines as Topic; D012871:Skin Diseases / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*
Critical care; Cuidados de enfermería; Cuidados intensivos; Insuficiencia respiratoria; Interface; Interfase; Lesiones cutáneas; Non-invasive ventilation; Nursing care; Respiratory insufficiency; Skin lesions; Ventilación no invasiva