The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Ongoing Skin Breakdown Rate Analysis Associated with Noninvasive Positive Pressure Ventilation (NPPV)- A Preliminary Report


Paul Luehrs RRT BSRT BSEd. CoxHealth, Springfield, MO

Background:  Noninvasive Positive Pressure Ventilation (NPPV) has evolved into a standard of care for patients in respiratory failure with causes ranging from COPD to neuromuscular diseases.  As a result the number of patient applications within the acute care hospital has increased, and will likely continue to increase in the foreseeable future.  One of the associated complications of NPPV is skin breakdown leading to ulceration at the patient-mask interface.  The impact of facial ulceration on a patient can range from infection to scarring.

Methods:  An Excel spreadsheet was created as a tool to record and track skin breakdown patients as well as other pertinent information.  In the spreadsheet we recorded the following parameters monthly: date, time identified, medical number, name, age, diagnosis, length of time on NPPV when the breakdown was identified.  As part of the spreadsheet we recorded the total number of NPPV setups/month.  Patients with skin breakdown could only be added to the spreadsheet once per admission.  Calculations were made from the recorded information.  We were interested in obtaining our true skin breakdown rate, which has been reported in the literature to occur in 5-10% of cases.1  The following information was calculated monthly:  % skin breakdown, average length of time on NPPV when breakdown is reported, average age of patient with skin breakdown, and the average length of time on NPPV for patients > 60 and < 60 years of age.

Results:  The months of March and April 2006 were analyzed.  The average age for NPPV patients with skin breakdown was 69.5 years of age.  The overall two-month skin breakdown percentage was 4.6%, which is on the lower end of reported values.  For patients < 60 years of age the average length of time on NPPV when skin breakdown was reported is 49.0 hours.  For patients > 60 years of age the average length of time on NPPV when skin breakdown was reported is 26.8 hours.  The overall average length of time on NPPV before skin breakdown is 37.9 hours.

Conclusions:  The skin breakdown spreadsheet is a tool designed to assist in analyzing skin breakdown rates and other associated parameters.  We have found that the older population of NPPV patients, (> 60 years), have a 45% higher rate of skin breakdown than patients < 60 years of age.  This information more clearly defines who is more likely to suffer from skin breakdown during NPPV and the time period after which skin breakdown is most likely.  The primary limitation of this study is the small group of patients with skin breakdown, which will grow as we continue to gather data.

1.  Respir Care 1997 42:432-437 

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