BENGALURU: Non-Invasive Ventilation (NIV), used in the treatment of acute respiratory failure and provided through a facial mask, is known to leave behind unhappy scars. Though it is used on severely-infected Covid patients, long use of NIV leads to skin damage, ulcers and conjunctivitis, and many patients are visiting hospitals to treat NIV scars. Hospitals are also opening special scar clinics.
A 44-year-old woman, with multiple comorbidities, was on NIV for an extended period without any formal monitoring of the underlying skin.
This resulted in a Grade II pressure ulcer, with broken skin and an open wound or pus-filled blister. The area turned red and swollen, and was very painful, forcing the patient to visit a private hospital. Despite the rim of the mask having a silicone cushion, pressure sores develop, especially on the bony prominences such as the bridge of the nose, forehead and cheeks.
The main challenge is among people with sensitive skin and Fitzpatrick skin type 3 to 6, as these marks or scars tend to pigment, leading to a condition called Post Inflammatory Hyperpigmentation (PIH). When these sores are allowed to settle on their own, those with stable skin and Fitzpatrick skin type 1 and 2 often tend to heal, but could leave behind scars that can remain for life.
At GVG Invivo Hospital, there is a sudden increase in patients coming in with NIV-related injuries. “It is better to minimise the scars with plastic surgery and energy-based treatments. We are starting a scar clinic to see these patients from November 1,” said Dr Gunasekar Vuppalapati, CMD, GVG Invivo Hospital.
Dr Jagadish Hiremath, CEO, Ace Suhas Multi-Speciality Hospital, said, “In a few patients, the marks remain for longer durations, and lead to serious issues.
Complications of NIV facial masks have been reported. NIV has its own limitations, pressure-related skin and tissue necrosis is one of them. The most important cause is pressure above the normal capillary filling pressure of the skin, along with factors such as poor hydration, hypotension and skin thinness due to anatomy and use of corticosteroids.”
The doctors stated that hospitals should follow guidelines that suggest continuous application of positive airway pressure (CPAP) for six to eight hours, with intermittent breaks.