Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
Int Wound J. 2022 Aug;19(5):1051-1063. doi: 10.1111/iwj.13701. Epub 2021 Oct 8.
Continuous positive airway pressure masks for breathing assistance are used widely during the coronavirus pandemic. Nonetheless, these masks endanger the viability of facial tissues even after a few hours because of the sustained tissue deformations and extreme microclimate conditions. The risk of developing such device-related pressure ulcers/injuries can be reduced through suitable cushioning materials at the mask-skin interface, to alleviate localised contact forces. Here, we determined the facial tissue loading state under an oral-nasal mask while using hydrogel-based dressing cuts (Paul Hartmann AG, Heidenheim, Germany) for prophylaxis, which is a new concept in prevention of device-related injuries. For this purpose, we measured the compressive mask-skin contact forces at the nasal bridge, cheeks, and chin with vs without these dressing cuts and fed these data to a finite element, adult head model. Model variants were developed to compare strain energy densities and effective stresses in skin and through the facial tissue depth, with vs without the dressing cuts. We found that the dry (new) dressing cuts reduced tissue exposures to loads (above the median loading level) by at least 30% at the nasal bridge and by up to 99% at the cheeks, across the tissue depth. These dressing cuts were further able to maintain at least 65% and 89% of their protective capacity under moisture at the nasal bridge and cheeks, respectively. The hydrogel-based dressings demonstrated protective efficacy at all the tested facial sites but performed the best at the nasal bridge and cheeks, which are at the greatest injury risk.
在冠状病毒大流行期间，持续气道正压通气面罩被广泛用于呼吸辅助。然而，由于持续的组织变形和极端的微气候条件，这些面罩即使使用几个小时后也会危及面部组织的活力。通过在面罩与皮肤的界面使用合适的缓冲材料，可以减轻局部接触力，从而降低因设备导致的压疮/损伤的风险。在这里，我们确定了在使用口腔-鼻腔面罩时，使用水凝胶基敷料（德国海登海姆的保罗·哈特曼公司）进行预防时，面部组织的加载状态，这是预防设备相关损伤的新概念。为此，我们测量了鼻桥、脸颊和下巴处的压缩面罩-皮肤接触力，同时使用和不使用这些敷料，然后将这些数据输入到一个有限元成人头部模型中。我们开发了模型变体，以比较有和没有敷料时皮肤和面部组织深度处的应变能密度和有效应力。我们发现，干燥（新）的敷料可以将组织暴露于负载（高于中位数负载水平）的情况减少至少 30%，在鼻桥处减少多达 99%，在整个组织深度上都是如此。这些敷料在鼻桥和脸颊处仍然能够保持至少 65%和 89%的保护能力，而在这两个部位，水分会降低其保护效果。这些水凝胶基敷料在所有测试的面部部位都表现出了保护效果，但在鼻桥和脸颊处的效果最好，因为这两个部位的损伤风险最大。
