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Anne-Kathrin Brill: improving comfort in non-invasive ventilation

Research to improve everyday handling and comfort for people using non-invasive ventilation masks

Project introduction - Mask-pressure effects in non-invasive ventilation

Non-invasive ventilation (NIV) is a technique used to support breathing when the lung is failing because of a severe lung disease or if the nerves and muscles that are involved in the lungs are not working properly. NIV can be used in the hospital in acute respiratory failure or for long-term treatment at home.

In NIV, positive pressure is applied to the airways by a facial mask placed over mouth and nose or the nose only. The mask is attached with headgear to obtain a comfortable and secure fit and to avoid air-leaks. Clinicians and patients are usually advised to tighten the headgear until the air-leak is controlled, but unfortunately masks are often over-tightened. Mask fitting and avoiding over-tightening the mask straps is often difficult, especially if the patient is not able to say if the mask is fitted comfortably, for example if they are affected by medication or have cognitive impairment or reduced neuromuscular function due to their condition. Therefore pressure effects may not be noticed until problems, such as pressure ulcers have already developed.

What is the research project?

The aim of my project is to:

To do this, I am developing a miniaturised pressure system that measures the pressure between the face and mask and can give both patients and caregivers independent feedback on the pressure applied.

I am working in collaboration with the bioengineering team of Imperial College London, UK. In the last few months I have learnt about the different techniques to measure pressure applied to the face by a mask. We have looked at indirectly measuring the pressure by measuring the tension on the straps attaching the mask to the face, and also at pressure measurement systems that can be placed between the mask and the skin. I will conduct tests on these different approaches to decide which is better for giving feedback on the tightness of the straps.

I am also working to identify risk factors for pressure ulcers caused by the mask and how mask management strategies can be improved to address these risks. I have reviewed the current literature and worked with the nurses and wound care specialists to update the hospital’s guidelines on mask pressure ulcer prevention. The findings of this work will be published in a teaching article on mask fitting in hospital care in the ERS journal Breathe.

What impact does the project have on patients and why is it important for people with respiratory failure?

People who use NIV have to wear a mask for many hours at night and sometimes during the day time. Exaggerated pressure on the face can cause discomfort, painfulpressure marks or pressure ulcers making people stop wearing the mask or to have ineffective. Children wearing masks that are too tight can stop the bones in the face growing properly. In this project we want to improve the everyday handling of NIV masks through better understanding of mask mechanics, measurements of mask pressure and the relationship between pressure and comfort. This will directly benefit people using NIV by increasing comfort, acceptance and quality of non-invasive ventilation and reducing the occurrence of facial pressure ulcers in NIV.

Why is this research important?

Finding and fitting the best mask for each person is key to successful therapy, but despite the improvements in mask design, mask related side-effects still occur frequently in NIV and remain a common reason for NIV failure. The use of NIV is increasing worldwide with more and more centres providing NIV services. This research is meant to improve strategies of mask fitting and to help patients and caregivers, especially for those new to using NIV when neither of them is experienced in mask handling.

What are the implications of your project for the treatment or clinical practice?

We can teach patients and caregivers how to fit the mask, but we also need a way of monitoring mask pressure more effectively. With the project I hope to develop a tool, which can improve the daily practice of mask fitting. This should help to provide better comfort, improve acceptance of therapy and reduce mask-related side-effects in the hospital and home environments and will thereby have a direct benefit for the patient.

With the support of the ERS and ELF this project may also help raise awareness of the problem of mask pressure effects to a wider audience, influence practical guidelines on mask management strategies and provide teaching material for healthcare professionals, patients and caregivers.