Investigation of factors affecting prevelence and formation of pressure wound in the face region in patients with noninvasive mechanical respiratory support

Non-invasive mechanical ventilation (NIMV); has become a widely used standard treatment in many acute and chronic respiratory failure situations. NIMV application has a wide range of applications, especially in intensive care units. Facial pressure injuries due to the mask used during NIMV treatment is one of the most important factors preventing the success of the treatment and it has a frequency of 7.0% to 100.0%. The aim of this study was to investigate the factors affecting the frequency and occurrence of pressure sores in the face region in patients receiving noninvasive mechanical respiratory support in the internal intensive care unit of the public hospital in Çaycuma district of Zonguldak province. In order to conduct the study, ethical permission was obtained from Zonguldak Bülent Ecevit University Non-Interventional Clinical Research Ethics Committee, written permission from the institution, and informed consent was obtained from patients or their relatives. The research was conducted between 01 February 2018 - 01 February 2019 with 33 patients. Research data; data collection form including individual characteristics, clinical findings and arterial blood gas values of the patient, "Glasgow Coma Score" to assess the patient's state of consciousness, "Simplified Acute Physiology Score" to determine the severity of the disease, patient-mask compliance assessment form, facial region skin assessment form and nursing care was achieved through the form of application strategies. Patients with the inclusion criteria were evaluated for the first 24 hours after the start of NIMV treatment and data were recorded at 2, 6, 12 and 24 hours of treatment. Descriptive statistical methods, Mann-Whitney U test, Friedman Test, Bonferroni corrected Wilcoxon signed-ranks test, Fisher's exact test and Fisher-Freeman-Halton exact test were used for the evaluation of the data. Statistical significance was accepted as p <0.05. As a result of the research, 81.8% of the patients had pressure sores on the face, 75.8% were stage I and 6.1% were stage II. since there is only one type of mask in the institution, oro-nasal masks were used during NIMV treatment. Only two patients were discontinued during the first two hours of treatment. Two patients with stage II facial pressure sores were covered with thin gauze. As a result of the evaluation of the data; the mean age of the patients who developed pressure sores in the facial region was 73.37 ± 13.43 (35-93) years, whereas the development of facial pressure sores was significantly higher in patients with chronic disease (X2 = 4.991, p = 0.058) and obese (86.7%). As a result; in order to determine the factors associated with the formation of facial pressure sores in patients receiving NIMV therapy, we recommend that larger studies, different types of masks, patients receiving NIMV therapy longer than 24 hours and longitudinal studies be performed. Keywords: NIMV, facial pressure wound prevalence, nursing care application strategies.