Departmental Bulletin Paper 非侵襲的陽圧換気療法のマスクによる圧迫創傷の発生要因の抽出
Risk factors of non-invasive positive pressure ventilation therapy mask-related pressure ulcers  

藤本, 由美子  ,  大桑, 麻由美  ,  中谷, 壽男  ,  真田, 弘美  ,  佐藤, 文

39 ( 2 )  , pp.37 - 50 , 2016-01-27 , 金沢大学つるま保健学会 = Tsuruma Health Science Society, Kanazawa University
Recently, the occurrence of medical device-related pressure ulcers (MDRPUs) caused by the tight application of face masks during non-invasive positive pressure ventilation (NPPV) treatment for serious respiratory disorders has attracted attention. Such ulcers can be life threatening because they make it difficult to continue NPPV, compounding the criticality of the respiratory disorder. However, as the masks cannot be removed, the factors involved in the development of such ulcers and the indices of their prevention have not been elucidated. To determine the factors involved in the development of pressure ulcers caused by tightly applied NPPV masks, we examined the skin condition of patients in the area covered by the mask and examined the causes based on the relationships between morphological characteristics of the face and external and internal factors. The study population consisted of 31 and 20 patients with and without pressure ulcers, respectively, representing a cumulative incidence rate of 60.8%. The most common site of pressure ulcers was the nasal bridge. Examining the depths of these ulcers showed that 28 patients had persistent blanchable erythemas, and three had ulcers that extended to the dermis, which were not seen at sites other than the nasal bridge. With regard to ulcer morphology, distinctive irregular shapes were seen with particular frequency on the nasal bridge. The variable for which a significant difference was seen was unsuitable mask size, and the number of patients fitted with masks of unsuitable size was higher among patients with ulcers (p=0.021). In addition, of the 13 patients for whom the mask size was unsuitable, seven had irregularly shaped ulcers, and all seven of these had mask shear. The results discussed above suggested that pressure and/or shear caused by application of an NPPV mask of unsuitable size was associated with the development of pressure ulcers. NPPV is performed for patients in critical condition, and for whom whole-body management is of the highest priority. However, the findings presented here suggest that after 24 hours, when the patientʼs condition has stabilized, selecting a suitable mask size can prevent pressure ulcers and that measures should be taken to reduce pressure and shear.

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