Yamaguti Wellington P, Moderno Eliana V, Yamashita Sandra Y, Gomes Thelma Gmc, Maida Ana Lígia V, Kondo Claudia S, de Salles Isabel Cd, de Brito Christina Mm
Rehabilitation Service, Physiotherapy Department, Hospital Sírio-Libanês, São Paulo, Brazil.
Respir Care. 2014 Oct;59(10):1530-6. doi: 10.4187/respcare.02942. Epub 2014 Jun 3.
Noninvasive ventilation (NIV) has been recognized as an effective strategy in preventing endotracheal intubation in subjects with acute respiratory failure (ARF). Some interface-related complications have also been recognized, such as skin breakdown (SB). The aim of this study was to determine the frequency of SB and identify potential treatment-related risk factors for its development in adults with ARF undergoing NIV or CPAP.
A cross-sectional study was conducted in a general hospital. Subjects were retrospectively enrolled in this study if they were > 18 y old and developed ARF caused by any condition in which NIV or CPAP was indicated for at least one application for a period longer than 2 h. The outcomes were the prevalence of SB and the evaluation of related risk factors. Data were extracted from the electronic medical records. A stepwise forward logistic regression model was used to identify independent risk factors for SB development.
A total of 375 subjects (160 males) met the inclusion criteria and were enrolled in the study. Fifty-four subjects (14.4%) developed SB. The mean number of applications of NIV or CPAP carried out for > 2 h was higher in subjects with SB (7.1 ± 13.3 h) than in those without SB (4.4 ± 13.3 h) (P = .03). Subjects with SB also presented a higher total duration of NIV use (44.6 ± 118.5 h) compared with subjects without SB (21.8 ± 45.5 h) (P = .01). Subjects who developed SB presented a higher use of oronasal mask (92.6%) compared with the group that did not (21.5%) (P < .001).
In patients with ARF undergoing NIV or CPAP, oronasal mask use for > 26 h was independently associated with development of SB.
无创通气（NIV）已被公认为是预防急性呼吸衰竭（ARF）患者气管插管的有效策略。一些与接口相关的并发症也已被认识到，如皮肤破损（SB）。本研究的目的是确定ARF成年患者在接受NIV或持续气道正压通气（CPAP）时SB的发生率，并识别其发生的潜在治疗相关风险因素。
在一家综合医院进行了一项横断面研究。如果受试者年龄>18岁，因任何需要NIV或CPAP且至少应用一次持续时间超过2小时的情况而发生ARF，则回顾性纳入本研究。观察指标为SB的发生率及相关风险因素评估。数据从电子病历中提取。采用逐步向前逻辑回归模型识别SB发生的独立风险因素。
共有375名受试者（160名男性）符合纳入标准并被纳入研究。54名受试者（14.4%）发生了SB。发生SB的受试者接受NIV或CPAP且持续时间>2小时的平均次数（7.1±13.3小时）高于未发生SB的受试者（4.4±13.3小时）（P = 0.03）。与未发生SB的受试者相比，发生SB的受试者NIV使用总时长也更长（44.6±118.5小时）（P = 0.01）。发生SB的受试者使用口鼻面罩的比例（92.6%）高于未发生SB的组（21.5%）（P < 0.001）。
在接受NIV或CPAP的ARF患者中，使用口鼻面罩>26小时与SB的发生独立相关。
