Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts

Abstract

Introduction: In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients.

Objectives: To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided.

Methodology: Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel.

Results: Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet^® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin.

Conclusions: The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis.

Keywords: Critical care; Cuidados de enfermería; Cuidados intensivos; Insuficiencia respiratoria; Interface; Interfase; Lesiones cutáneas; Non-invasive ventilation; Nursing care; Respiratory insufficiency; Skin lesions; Ventilación no invasiva.