Abstract
Background:
Noninvasive ventilation (NIV) contributes to the development of pressure injury (PI) in a significant number of hospitalized pediatric patients. PIs contribute to higher costs for the hospital, patient pain and suffering, increased infection rate, disfigurement, and length of stay. While skin contact pressure has been investigated for correlation with pressure injury, there is very little information about the amount of leak acceptable for maintaining NIV. This study aims to examine the relationship between NIV device-related PIs, mask leak, and other risk factors.
Methods:
An IRB approved observational retrospective chart review was conducted on all pediatric patients on NIV with Respironics BiPAP ST machine at a 551 bed Pediatric Hospital from July 1, 2013-June 30, 2015. Patients who use NIV at home and CPAP only were described as a separate group for review. Patients off NIV > 24 h, and restarted within the same admission, were assigned as an additional NIV event. PIs were described using NPUAP scale. The following variables were collected for correlation: Braden Q scores, days in hospital, time on NIV, presence/absence of PI, PI severity, time to PI formation, style of mask, frequency of mask alternating/repositioning, amount of leak, PIP, presence of chronic diagnosis, age, and gender. Data analysis was completed using descriptive statistics for all outcome and predictor variables.
Results:
255 subjects age 2 months—35 y (mean 11.25 y) with 343 events were enrolled. Of these events, 7.2% (25/343) developed PIs. One patient had PI during the same admission, but separate NIV event. The correlation of max leak (P=0.005), min leak (P=<0.001), and leak 9th percentile (<0.01) were statistically significant with the development of PIs. Other variables that significantly correlated with PIs include age (P=0.008), time on NIV (P=0.002), Braden Q (P=0.011), and max IPAP level (<0.001). There was no correlation between patients who use NIV and PI versus those who do not.
Conclusions:
Identifying the primary factors that correlate with NIV device related hospital acquired PIs promotes frequent monitoring of skin integrity, especially in those with correlating risk factors. Having identified minimum and maximum leaks as statistically significant in pediatric patients provides us with new knowledge that can help us in assessing proper fit of our interface.
Disclosure: Ellen Browning Scripps Foundation Research Scholarship.
Scatter plots of time on NPPV by each Variable of Interest
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