The right interface for the right patient in noninvasive ventilation: a systematic review

ABSTRACT

Introduction

Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy.

Areas covered

This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here.

Expert opinion

The paradigm ‘The right mask for the right patient’ seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients’ needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.

KEYWORDS:

• Interface
• mask
• NIV
• noninvasive ventilation
• pressure support ventilation
• continuous positive pressure ventilation
• CPAP
• nasal mask
• oral mask
• oronasal mask
• total face mask
• nasal pillows
• helmet
• hybrid mask
• mouthpiece
• custom mask

Article highlights

• There are many different interfaces commercially available, and sometimes the choice of the right interface may become challenging. This manuscript aims to provide an accurate literature review to help the clinician in the day to day clinical practice.

• In order to understand the peculiarity of each interface all the technical aspects are described in full details either the actual constitution parts or the manufacturing of the interface or the details related to the setting and use in practice.

• The acute and the chronic setting are the two clinical scenarios where interface and NIV become necessary.In the acute setting, Fiberoptic bronchoscopy procedure may be required, therefore helmets, total or full face, or oro-nasal interfaces may be preferred.

• In the chronic setting other NIV interfaces may be instead more comfortable to initiate NIV with, such as small nasal interface, mouthpiece, oral or hybrid interfaces.

• Many pitfalls and new opportunities are described in the present manuscript to help the clinician disentangle in difficult clinical scenario and to provide with the right interface choice.

• A patient-centered perspective is always advisable when choosing an interface. New research focusing on developing advanced and tailored NIV masks should be prioritized, and interfaces should be designed according to the specific clinical setting where they need to be used.

Acknowledgments

All authors would like to thank Dott. E. Lella for the English revision of the manuscript, and Dott D. Portacci for her contribution in drawing all interfaces figures.

Declaration of Interest

C Gregoretti has received honoraria for lectures or consultancies from Vivisol, Philips, Mindray, and Air Liquid (outside the submitted work), and declares a patent in association with the University of Palermo-Italy (No 102,019,000,020,532-Italian Ministry of Economic Development). G Misseri declares a patent in association with the University of Palermo-Italy (No 102,019,000,020,532-Italian Ministry of Economic Development). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2022.2121706

Additional information

Funding

This paper was not funded.