Facial side effects during noninvasive positive pressure ventilation in children

Intensive Care Med. 2005 Jul;31(7):965-9. doi: 10.1007/s00134-005-2669-2. Epub 2005 May 28.


Objective: The study quantified the side effects of nasal masks use for noninvasive positive pressure ventilation (NPPV) in children.

Design and setting: Cross-sectional retrospective study in a tertiary pediatric university hospital.

Patients: Patients with obstructive sleep apnea (n=16), neuromuscular disorders (n=14), and cystic fibrosis (n=10).

Interventions: Clinical evaluation of facial tolerance.

Measurements and results: A skin injury was observed in 19 patients (48%), with a transient erythema in 7 (18%), prolonged erythema in 9 (23%), and skin necrosis in 3 (8%). Skin injury was associated with age over 10 years (OR=16) and use of a commercial mask (OR=15) and was less frequent in patients with obstructive sleep apnea. The change of a commercial mask for a custom-made mask was associated with reduction in the skin injury score. Global facial flattening was present in 68% of the patients. No correlation was observed with age, daily or cumulative use of NPPV, or the type of mask. A maxillary retrusion was present in 37% of patients. No correlation was observed with age or the type of mask or the underlying disease, but an association was found with a longer daily use of NPPV (OR=6.3).

Conclusions: The prevalence of facial side effects is clinically significant in children using NPPV. Systematic maxillofacial follow-up enables these effects to be identified. Remedial measures could include the change of the interface or reducing the daily use of NPPV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Facial Injuries / etiology*
  • Female
  • Humans
  • Infant
  • Male
  • Masks / adverse effects*
  • Positive-Pressure Respiration / methods*
  • Retrospective Studies
  • Skin / injuries*