The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Anne Schaer, Mike Trevino, David Mussetter, Gary Weinstein; Cardiopulmonary, Texas Health Presbyterian Hospital Dallas, Dallas, TX

Background: We are a 903 bed acute care teaching facility serving a major metropolitan area. Our Respiratory Therapy Department strives to meet quality, cost and service goals through continuous quality improvement projects. Anecdotal reports have arisen over concerns regarding skin integrity. A literature search revealed little information on skin breakdown associated with BIPAP or CPAP masks. The only information found was skin staging related to pressure ulcers (i.e. decubitus ulcers). Our goal was to quantify any problems our hospital might be having with these issues and to attempt to find a solution. Method: One therapist did random patient checks to assess skin integrity of patients receiving non-invasive positive pressure (CPAP or BIPAP) therapy; this included continuous and nocturnal use. 315 adult patients receiving non-invasive positive pressure therapy over a 3 month period were assessed. Information gathered included age, sex, length of time on device, and the delivery device (type mask). The Braden Scale was used to stage skin integrity. Results: Of the 315 patients, only 9 (2.86%) had stage 1 breakdown (slight redness, nonblanchable redness), leaving the other 306 (97.14%) patients with no issues identified. The 9 noted with stage 1 breakdown were all on for greater than 8 days continuously, and all between the ages of 25-65. Of the 9, 3 were hemodynamic unstable with unfavorable outcomes and poor nutritional status. Conclusion: While our data showed a relatively low rate of skin integrity problems, our goal is to have no instances of this nature. As a department we implemented a BIPAP/ CPAP reevaluation, meaning any patient receiving nocturnal or continuous therapy will be assessed (every morning for nocturnal and every 4 hours for continuous) for skin integrity, as well as mask or machine related issues. Monitoring found opportunities for nursing and respiratory therapy education related to proper fitting of the delivery interface. Sponsored Research - None