Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

ABSTRACT Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

摘要
目的：探讨无创通气（noninvasive ventilation）输注装置与早产儿（preterm infants）鼻中隔损伤（nasal septum injury）发生率的关联。
方法：本回顾性单中心队列研究（retrospective single-center cohort study）纳入接受无创通气支持的早产儿，根据无创通气输注装置分为三组：G1组采用鼻面罩（nasal mask）、G2组采用双鼻塞（binasal prongs）、G3组采用鼻面罩与鼻塞轮换使用，比较三组鼻部损伤的发生率。鼻部损伤参照国家压疮咨询委员会（National Pressure Ulcer Advisory Panel）标准分为1~4期。采用多变量回归分析（multivariate regression analyses）估算相对风险（relative risks），以识别与医疗器械相关损伤（medical device-related injuries）相关的潜在预测因素。
结果：本研究共纳入300例早产儿，轮换组的医疗器械相关损伤发生率显著低于持续使用面罩或鼻塞组（轮换组n=68，占比40.48%；P<0.01）。双鼻塞组的2期损伤例数更多（n=15，占比55.56%；P<0.01）。无论使用何种装置，无创通气时长≥7天均与更高的医疗器械相关损伤发生率相关（该亚组占比63.81%；P<0.01）。无创通气每日使用时长每增加1天，鼻部损伤风险升高4%（95%置信区间（95%CI）：1.02~1.06；P<0.01）。较高的出生体重（birth weight）对医疗器械相关损伤具有保护作用：出生体重每增加1g，鼻中隔损伤风险降低1%（相对风险RR=0.99；95%置信区间（95%CI）：0.99~0.99；P<0.04）。
结论：与单一装置相比，鼻面罩与鼻塞轮换使用可降低中重度鼻部损伤的发生率。无创通气使用时长增加似乎会增加医疗器械相关损伤的发生风险，而较高的出生体重是保护性因素。