Interface Pressures at the Bridge of the Nose: Prevention and Treatment

Noninvasive ventilation (NIV) has assumed a prominent role in the treatment of patients with both acute and chronic respiratory failure. The correct choice of the interface (type and size of the mask) to be used is fundamental both for NIV effectiveness, but also to prevent any complications including injuries and facial pressure ulcers. The nose is the most frequent site of the appearance of skin breakdown and ulcers. When the interface for NIV is applied incorrectly, the high pressure generated to the bridge of the nose leads to skin breakdown and pressure ulcer formation. Necrosis can extend to deeper structures such as subcutaneous tissues, cartilage and nasal bones leading to permanent damage. For these reasons, the nasal and/or oronasal mask must be carefully chosen by the physician based on the patient’s characteristics and environmental factors. Furthermore, the healthcare staff in hospitalized patients, the patient himself, and his caregivers must all be trained to recognize any critical issues and to use different approaches for preventing nasal lesions. Besides, health-care staff must be able to recognize and treat any nasal lesions early before they are complicated with ulcers and irreversible lesions. The lack of attention to these seemingly trivial factors can lead to NIV failure and permanent damage that may be susceptible to legal remedies.