2012 OPEN FORUM Abstracts
EVALUATION OF INTERVENTIONS TO TREAT AND PREVENT PRESSURE ULCERS ASSOCIATED WITH MASK INTERFACES DURING PEDIATRIC NON-INVASIVE VENTILATION.
Cynthia C. White1, Thomas J. Cahill1, Marty O. Visscher2; 1Division of Respiratory Care, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH; 2Associate Director, Pediatric Plastic Surgery, Cincinnati Childrens Hospital Medical Center, Cincinnati OH, OH
Background: Many factors place pediatric patients at risk for developing pressure ulcers (PUs). Previous data collected at our institution revealed 57% of pediatric PUs were related to medical devices. A large number were caused by face masks used for NIV and 46% of pediatric patients with PUs were found to have conditions related to craniofacial anomalies. This factor may further complicate mask fit. Applied pressure from the device itself and increased hydration due to occlusion at the mask/skin interface may also contribute to PUs. Moist skin may result in more friction leading to skin trauma, blister formation, etc. Our collaborative team designed a study to measure hydration underneath the face mask of patients on NIV. We hypothesized that there would be no difference in hydration measurements of skin directly under the mask in comparison to the control sites when utilizing one of 3 interventions to treat or prevent PUs. Methods: Patients who developed either visible redness or a PU received 1 of 3 interventions depending on respiratory support and availability of alternative interfaces : 1) Mepilex lite® between the mask and skin, 2) Vigilon® (a gel substance) between the mask and the skin or 3) Sleepweaver® (Circadiance, Export, PA) cloth nasal mask. Twenty-seven patients were enrolled to generate data on face masks alone (n=111), Mepilex (n=24), Vigilon (n=6), and Sleepweaver (n=62). Skin hydration was measured as capacitive reactance using the NOVA Dermal Phase Meter 9003 (NOVA Technology, Glouster, MA) immediately following mask removal. Normal skin areas adjacent to the mask, were measured as a control at each site. Data was analyzed using general linear models with significance at p < .05. Results: Hydration was significantly increased at the mask/skin interface compared to the control at all measured sites. The skin under both Vigilon® and Mepilex Lite® are directionally more hydrated than the control. The skin hydration at contact points of the Sleepweaver® was not different than the control (p=.24). None of the patients developed a PU while wearing the Sleepweaver® mask. Discussion: Skin hydration increases under face masks during pediatric NIV. The Sleepweaver® utilizes a more breathable cloth material which may decrease risks of accumulating moisture underneath the mask. Barriers such as Vigilon® and Mepilex Lite® may reduce hydration, but additional data is need to define their role in preventing and treating PUs. Sponsored Research - None