Comparison of oronasal and nasal masks in home mechanical ventilation: an observational cohort and bench study

In patients with chronic respiratory failure, home non-invasive ventilation (NIV) is delivered through oronasal or nasal masks. Masks are a cornerstone for NIV success but can be associated with side-effects. However, the type, frequency and consequences of these side-effects are unknown. Here, we aimed to study the prevalence, nature and impact of mask-related adverse events in a cohort of stable patients. We then investigated differences between oronasal and nasal masks both in our cohort and in a bench study.

This was a prospective observational cohort including patients established on long-term NIV admitted for their elective review. Data regarding mask-related side-effects were assessed using a structured questionnaire. Our bench study was performed using a three-dimensional printed head connected to an artificial lung.

800 patients were included, of whom 84% had an oronasal mask. Moderate to very severe mask-related side-effects occurred in 47% of patients and severe to very severe side-effects occurred in 18% of patients. Side-effects were associated with poorer daytime arterial partial pressure of carbon dioxide (p=0.005), poorer subjective sleep quality (p=0.003) and poorer quality of life (p<0.001). Mask-related side-effects were more frequently reported with the use of oronasal masks compared to nasal masks (p=0.023). Our bench study showed that nasal masks were more stable than oronasal masks (p<0.001).

Mask-related side-effects are frequent and associated with poorer outcomes. Our data suggest that nasal masks may have a better tolerance profile and should be used as a first-line interface.