Residual upper airway obstruction during nocturnal noninvasive ventilation despite high positive expiratory pressure. Impact of oronasal mask to nasal mask switch

Pierre Tankéré; Marjolaine Georges; Caroline Abdulmalak; Deborah Schenesse; Guillaume Beltramo; Amaury Berrier; Philippe Bonniaud; Claudio Rabec

doi:10.1016/j.resmer.2023.101083

Residual upper airway obstruction during nocturnal noninvasive ventilation despite high positive expiratory pressure. Impact of oronasal mask to nasal mask switch

Respir Med Res. 2023 Dec 25:85:101083. doi: 10.1016/j.resmer.2023.101083. Online ahead of print.

Authors

Pierre Tankéré¹, Marjolaine Georges², Caroline Abdulmalak³, Deborah Schenesse¹, Guillaume Beltramo⁴, Amaury Berrier¹, Philippe Bonniaud⁴, Claudio Rabec⁵

Affiliations

¹ Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France.
² Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, INRA, UMR 6265 CNRS 1234, University of Bourgogne Franche-Comté, Dijon, France.
³ Department of Intensive Care Medicine, William Morey General Hospital, Chalon-Sur-Saône, France.
⁴ Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France; INSERM, LNC UMR1231, LipSTIC LabEx Team, Dijon, France.
⁵ Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France. Electronic address: claudio.rabec@chu-dijon.fr.

PMID: 38232657
DOI: 10.1016/j.resmer.2023.101083

Abstract

Background: Nasal mask (NM) and oronasal masks (OM) can be used to provide noninvasive ventilation (NIV). Recent studies suggested that OM is the most used interface and that there is no difference in efficacy or in tolerance between OM and NM for chronic use. However, studies focusing on video laryngoscopy underlined the impact of OM in residual upper airway obstruction (UAO) under NIV. We sought to assess the real-life practice of switching from OM to NM when UAO events persist despite high EPAP levels.

Methods: In an open-label single center prospective cohort study, data from files and full night polysomnography on NM and OM were collected for patients wearing OM and presenting an UAO index ≥15/h despite an EPAP level ≥ 10 cmH20.

Results: Forty-four patients were included in the study. In 31 patients (74 %), switching to a NM reduced UAOi to ≥10/h. Interestingly, 92 % of these patients still had NM at 3 to 12 months of follow-up. Switching to a NM was also associated with a trend in paCO2 reduction and significant improvements in Epworth, sleep quality and NIV compliance. Successful interface switching was significantly associated with female gender, and a trend was observed in non-smokers.

Conclusion: As for CPAP, switching to a NM improved NIV efficacy in a selected group of patients presenting residual UAO events despite high EPAP levels. Additionally, this switch has an impact on compliance and subjective sleepiness. Thus, in patients with persisting UAO on OM, switching to a NM could be a first-line intervention before considering further investigation such as polygraphy or video laryngoscopy. We also derive an algorithm for mask allocation and adaptation in acute and chronic NIV use.

Keywords: Interface; Mask; NIV; Non invasive ventilation; Residual obstruction.