Insuffisance respiratoire aiguë et ventilation non invasive : choix de l'interface

Apart from the choice of ventilator type, mode and setting, another crucial issue when starting noninvasive ventilation is to find an optimal interface. The best choice of the mask for a patient with acute respiratory failure must be made by a technical referent. Even if a type of interface is regularly used in an intensive care unit, it is necessary to study new interfaces. Technological progress on the masks and the improvements of the design of mask made it possible to increase comfort and to reduce the rates of complication, with the presumption which they will lead to reduced failure rates of noninvasive ventilation. Concerning the choice of the interface, the efficacy of non invasive ventilation to unload the respiratory muscles remains the priority and the facial mask is a reasonable first choice for acute application of noninvasive ventilation. However, it is necessary to quickly evaluate the skin ulceration and the nasal skin breakdown. Considering that no ideal interface exists, one can recommend having various types of interfaces available in order to choose it on an individual basis. The choice of second intention will relate to facial masks of new generations or the total facial masks. In contrast to face mask, the helmet, a new interface, does not make contact with the patient's face, thus avoiding skin lesions and improving patient comfort. Recent studies have demonstrated that, although improvement in oxygenation was similar, intolerance to ventilatory treatment, incidence of skin necrosis, gastric distension, and eye irritation were less common with the helmet than with the face mask. However, the helmet interface can be less efficient than facial masks to deliver noninvasive ventilation, particularly in conditions of increased workload. The low elastance and high inner volume of the helmet that caused a significant overdamp of pressure assistance and a deviation of ventilator-delivered flow from the patient, must be put in balance with the principal advantage obtained by respecting the integrity of the face. In practice, in many units including ours, the “helmet” is used only in second, even third intention, like alternative to the facial mask in the event of skin lesion responsible for intolerance with a risk of noninvasive ventilation failure.