Zakrajsek Anne D, Kesterson Lissy, Visscher Marty O, Narendran Vivek, Hoilett Orlando S, Nauman Eric A
Drs. Zakrajsek and Hoilett are affiliated with Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio.
Ms. Kesterson is affiliated with Neonatal Intensive Care Unit, Women's Health, University of Cincinnati Medical Center, University of Cincinnati, Cincinnati, Ohio.
Respir Care. 2025 Apr;70(4):417-426. doi: 10.4187/respcare.12217. Epub 2025 Jan 28.
The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive respiratory support. Since most patients receive nasal bubble CPAP a concomitant increase in nasal pressure injuries followed. This prospective observational study aimed to develop strategies to reduce nasal mask pressure injury in neonates by (1) quantifying CPAP mask-interface pressure and (2) assessing placement variability. A micro-electromechanical systems pressure sensor was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cm HO and 8 L/min of flow with no humidification. Pressure was measured at 3 locations (the forehead, nasal bridge, and philtrum) in triplicate (3 measurements/site). Descriptive statistics; a location-specific, one-way analysis of variance with a Tukey post hoc test; and a 2-sample paired test of the means of the first and last triplicate were performed. Pressure ranged from 12-377.3 mm Hg. The mean [SD] interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum 173.9 [101.3], nasal bridge 67.8 [28.9], and forehead 79.0 [36.9], < .001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.
2014年美国儿科学会推荐使用持续气道正压通气（CPAP）作为机械通气的替代方法来治疗新生儿呼吸窘迫，这促使治疗迅速转向无创呼吸支持。由于大多数患者接受鼻泡CPAP治疗，随之而来的是鼻压伤的发生率增加。这项前瞻性观察性研究旨在通过（1）量化CPAP面罩与面部的接触压力以及（2）评估放置的可变性来制定减少新生儿鼻面罩压力性损伤的策略。对一个微机电系统压力传感器进行了改进，通过硅树脂嵌入来进行接触压力测量并进行校准。CPAP发生器和接口组件的尺寸适合24周龄的新生儿模拟器。13名新生儿重症监护室的工作人员将模拟器置于CPAP上，压力为6 cm水柱，流速为8 L/分钟，无湿化。在三个位置（前额、鼻梁和人中）进行压力测量，每个位置重复测量三次（每个部位测量3次）。进行了描述性统计分析；进行了特定位置的单因素方差分析及Tukey事后检验；并对第一次和最后一次重复测量的均值进行了双样本配对检验。压力范围为12 - 377.3 mmHg。人中处的平均[标准差]界面压力显著高于鼻梁和前额（人中173.9 [10 [101.3]，鼻梁67.8 [28.9]，前额79.0 [36.9]，P < 0.001）。CPAP的固定方式各不相同，包括帽子放置、躯干角度、面罩压迫、使用钩环延长器以及实现的有力气泡反馈水平。本研究开发了一种改良的压力传感器，用于量化鼻面罩对面部皮肤施加的压力。最大压力高于先前报道的数值。在压力的定量和定性测量方面均存在个体差异。通过无创通气固定技术培训以及改善鼻面罩的稳定性和尺寸增加，可以减少与无创通气相关的压力性损伤。
