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

Interface Mask NIV Non invasive ventilation Residual obstruction

Journal

Respiratory medicine and research
ISSN: 2590-0412
Titre abrégé: Respir Med Res
Pays: France
ID NLM: 101746324

Informations de publication

Date de publication:
25 Dec 2023
Historique:
received: 23 03 2023
revised: 08 12 2023
accepted: 15 12 2023
medline: 18 1 2024
pubmed: 18 1 2024
entrez: 17 1 2024
Statut: aheadofprint

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1016/j.resmer.2023.101083 PMID: 38232657
pubmed: 38232657
pii: S2590-0412(23)00095-8
doi: 10.1016/j.resmer.2023.101083
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101083

Informations de copyright

Copyright © 2023 SPLF and Elsevier Masson SAS. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest All authors declare no competing interests.

Auteurs

Pierre Tankéré (P)

Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France.

Marjolaine Georges (M)

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.

Caroline Abdulmalak (C)

Department of Intensive Care Medicine, William Morey General Hospital, Chalon-Sur-Saône, France.

Deborah Schenesse (D)

Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France.

Guillaume Beltramo (G)

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.

Amaury Berrier (A)

Dept of Pneumology and Intensive Care Unit, Reference Centre for Rare Lung Diseases, Dijon University Hospital, Dijon, France.

Philippe Bonniaud (P)

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.

Claudio Rabec (C)

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.

Classifications MeSH