Effect of Humidified Noninvasive Ventilation on the Development of Facial Skin Breakdown

Abstract

Background: The use of noninvasive ventilation masks is known to cause damage to facial skin tissue, which affects both the efficacy of the intervention and the patient's quality of life. The use of humidification with noninvasive ventilation is a common practice, but its relative role in the development of facial pressure ulcers has not been fully studied.

Methods: A crossover cohort design was used in this study, with 15 healthy volunteers. Each volunteer randomly received both 10 cm H₂O of CPAP with and without humidification through an oronasal mask. Skin integrity was evaluated by measuring transepidermal water loss, skin hydration, and skin pH at the bridge of the nose. Device-skin interface conditions (pressure and microclimate) were recorded at the bridge of the nose and both cheeks. The pro-inflammatory cytokine interleukin-1α was collected from the nose bridge before and after CPAP application by using a skin analysis tape. Nasal symptoms were collected by using a validated 6-point score.

Results: Humidified CPAP significantly increased transepidermal water loss (P < .001) and skin humidity (P = .02) compared with non-humidified CPAP. There were no significant differences in skin hydration, skin pH, skin temperature, and cytokine expression between both conditions. However, there was a trend of increased median ratios of interleukin-1α concentrations in the humidified CPAP. There was a significant increase in the interface pressure at the bridge of the nose after CPAP application (P = .02), with higher interface pressure values at the nose bridge compared with both left (P = .002) and right (P = .003) cheeks. The participants reported elevated nasal discomfort during non-humidified CPAP.

Conclusions: These findings indicated that noninvasive ventilation with humidification had a potential disrupting effect on the barrier function of facial skin, associated with changes in skin microclimate and function. Further research is required to establish the cause of mask-related skin damage and to evaluate the effects of mask design, application techniques, and air flow and humidity settings.

Keywords: face mask; humidification; interface pressure; noninvasive ventilation; pressure ulcer; skin damage; skin hydration; skin integrity; skin microclimate.