Choosing the right noninvasive ventilation (NIV) mask

Michael Allison, MD
26th Nov 2020

For noninvasive ventilation (NIV) to be successful, patients must adhere to the therapy you prescribe. In many cases, this has a lot to do with the mask interface that is provided for the patient. Here, we’ll review the different types of mask interfaces you can choose from.

There are many varieties of masks that are used for the delivery of NIV which can be broadly categorized into nasal masks, facial masks (which can be partial or total), and helmet masks. There is no lack of ingenuity of design, as a quick internet search for NIV masks can result in dozens of varieties. Despite the myriad of options, the selection of masks in the inpatient setting is limited: the most common masks are the oronasal face mask, used in the majority of cases, followed by nasal masks, full face masks (not shown), and helmets.

Three faces with three types of noninvasive ventilation masks: one covering nose, covering nose and mouth, full head. Cartoon.

Figure 1. Three of the most common noninvasive ventilation (NIV) masks are (oronasal or partial) face masks, nasal masks, and helmets.

Despite decades of research in NIV and frequent use of NIV in clinical settings, a statement published in 1994 still rings true with regards to the choice and selection of facial masks: “The optimal interface and ventilator design have not been determined, and these may differ among patients.”

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Face masks

Face masks are the most common interface used in acute respiratory failure. Due to the inspiratory demand of patients with respiratory failure, many patients utilize their mouths for inspiration to bypass nasal resistance. A face mask that covers the mouth and nose, or less commonly one that covers the mouth, nose, and eyes, can provide a comfortable fit while preventing pressure loss due to air leaking from the perimeter of the mask.

Nasal masks

Nasal masks are most commonly used for long-term ventilation but can also be used for acute hypoxic or hypercapnic respiratory failure. The two most common varieties are nasal masks, which cover the nose, and nasal pillows, which support tubing that inserts externally into the nares. 

Both types allow for eating and drinking, patients can better tolerate coughing, and there are fewer complaints of claustrophobia with this interface.

Helmets

Helmet interfaces are the least common but have recently shown the most promise with regards to NIV. 

They have a collar attached at the neck and shoulders and a hood that allows for gas exchange. There are two ports into the helmet—one for gas entry and one for exhalation of expired gases. A small study recently conducted in patients with acute respiratory distress syndrome (ARDS) demonstrated good outcomes in patients with helmet interface NIV.1 

To allow patients the greatest benefit from NIV you may need to rotate between the different mask interfaces. Due to the pressure placed by the tight fit of an oronasal mask, allowing a break with a nasal pillow may allow for a longer duration of prescribed therapy and reduce the potential complications of skin breakdown.

That’s it for now. If you want to improve your understanding of key concepts in medicine and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.

References

  1. Patel, BK, Wolfe, KS, Pohlman, AS, et al. 2016. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 315: 2435–2441. PMID: 27179847

Recommended reading

  • Allison, MG and Winters, ME. 2016. Noninvasive ventilation for the emergency physician. Emerg Med Clin North Am. 34: 51–62. PMID: 26614241
  • Antonelli, M, Pennisi, MA, and Conti, G. 2003. New advances in the use of noninvasive ventilation for acute hypoxaemic respiratory failure. Eur Respir J Suppl. 42: 65s–71s. PMID: 12946003
  • Meyer, TJ and Hill, NS. 1994. Noninvasive positive pressure ventilation to treat respiratory failure. Ann Intern Med. 120: 760–770. PMID: 8147550