A properly fitted NIV mask will help facilitate effective oxygen delivery and may contribute to improved patient comfort and satisfaction. But there is no one size fits all approach because patient anatomy can vary greatly.

Be sure to select the right mask size by using sizing gauges supplied by the mask manufacturer. Select a mask featuring an individually adjustable cushion, which allows the clinician to achieve an anatomical fit and effective seal. Selecting the correct type of interface greatly reduces painful skin breakdown and ulcerations.

Mask leaks are an inherent part of delivering NIV to patients. While intentional air leaks are incorporated in mask design and NIV circuits to permit CO2 removal,^iv  unintentional air leaks around the edge of the mask may result in inadequate inspiratory flow demand. 

Therefore, managing leaks around the patient interface with a properly sized and fitted patient mask also requires a ventilator that can meet both patient and clinician requirements. The device should be able to meet and exceed the patient’s flow demand all while in the presence of leaks. This combination may help improve patient comfort and ultimately successful NIV.

An analysis of medical-device-related pressure ulcers found 70% of the wounds caused by medical devices occurred on the head, face and neck.^v Face masks for NIV have been associated with a high percentage of pressure ulcers, for which Medicare denies payment.^vi

To prevent pressure ulcers from forming, clinicians should regularly remove the patient’s mask and examine the skin looking for redness, irritation and breaks in the skin.

For patients with skin irritation from the mask and/or for those who are at increased risk for pressure ulcers (e.g., age 60+, type-2 diabetes),^vii clinicians should consider the use of hydrocolloid and gel sheets that can be placed between the skin and NIV mask. 

Research has shown hydrocolloid dressings placed over the nasal bridge in patients requiring NIV reduced the risk of developing grade 2 pressure ulcers.^viii Some masks feature built-in silicone gel technology to help reduce complications, such as pressure points and skin irritation.

Selecting the correct type of interface greatly reduces painful skin breakdown and ulcerations. For longer NIV therapy, it is recommended to alternate between different mask interfaces to decrease skin breakdown by varying the pressure points on the skin. An alternating interface strategy not only reduces the points of highest pressure, but also improves NIV tolerance and efficacy.^ix,x 

The proper face mask design and fit can have a significant impact on NIV delivery – but the ventilator is as critically important. You need the right mask paired with the right device to meet your patient demands.

Select a NIV ventilator that is compatible for use with high-quality masks that are available in a wide range of sizes and shapes and can be adjusted to patient anatomy.

A ventilator that supports all modes of invasive and noninvasive ventilation allows a greater degree of treatment options for the patient. It also streamlines clinical workflows, especially for those patients that may need to escalate from NIV to invasive ventilation without delay.^xi

^iv _{Roca O, Masclans JR. Interfaces in non-invasive ventilation: one mask doesn't fit all. Minerva Anestesiol. 2015;81(5):478-479.}