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Aylin Ozsancak, MD; Samy Sidhom, MD, MPH; Timothy N. Liesching, MD, FCCP; William Howard, RRT; Nicholas S. Hill, MD, FCCP
Author and Funding Information

From the Baskent University Hospital (Dr Ozsancak); Tufts Medical Center (Drs Sidhom and Hill and Mr Howard); the Lahey Clinic (Dr Liesching); and Rhode Island Hospital (Dr Hill), Providence, RI.

Correspondence to: Nicholas S. Hill MD, FCCP, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 800 Washington St #257, Boston MA 02111; e-mail: nhill@tuftsmedicalcenter.org


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Hill has received research grants from Respironics, Inc and Breathe Technologies, Inc. Drs Ozsancak, Sidhom, Liesching and Mr Howard have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1104. doi:10.1378/chest.11-1735
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To the Editor:

We appreciate the interest of Dr Barbarito and colleagues in our recent study1 comparing the total face mask (TFM) with oronasal mask (ONM) for the treatment of acute respiratory failure in patients receiving noninvasive ventilation (NIV). Our primary (mask comfort and time to apply) and secondary (vital signs and gas exchange parameters over time) end points showed no differences. In the interest of conserving space, we did not show the data for the time course of Paco2 in the two groups. Figure 1 shows that data after purging of early discontinuers (ie, those who discontinued NIV while still requiring ventilatory assistance) to provide a better idea of evolution over time.

Figure Jump LinkFigure 1. Data after removal of those who discontinued noninvasive ventilation while still requiring ventilatory assistance. ONM=oronasal mask; TFM=total face mask.Grahic Jump Location

Dr Barbarito and colleagues also requested information on the total duration of mechanical ventilation. As they mention, the median duration of NIV use was longer with the ONM than the TFM, excluding the duration of use after switching to the alternative mask. However, when that duration is included, the total duration of NIV was similar. If, as Barbarito and colleagues request, we exclude those who discontinued early, the median duration of NIV tended to be shorter in the ONM group (23 h; interquartile range, 4.6-51.3; n=18) than in the TFM group (56.9 h; interquartile range, 15.7-98.4; n=12). The reason for these disparities is that more patients discontinued NIV early with a shorter duration of use in the TFM than the ONM group (n=16 vs 12, 0.7 vs 3.7 h), and patients using ONM were more apt to switch to the alternative mask (n=8 of 16 patients using TFM vs 0 of 12 patients using ONM, P < .05).

This disparity in willingness to switch between the two groups is remarkable, and Barbarito and colleagues ask for more detail on the reasons. Of the 12 patients using ONM who discontinued NIV early, five required prompt intubation. Two other patients had do-not-intubate orders and died while using the mask. The other five patients were offered the TFM but declined. One was claustrophobic and refused any other masks; the other four were frightened by the large appearance of the TFM and declined. One of the patients using ONM compared with none of the patients using TNM had previously used NIV at home. As mentioned in the article,1 respiratory therapists were instructed to apply every effort to encourage patients to use either mask type. However, since blinding was not possible, we cannot exclude the possibility that clinician bias played a role in this disparity in willingness to switch.

Ozsancak A, Sidhom SS, Liesching TN, Howard W, Hill NS. Evaluation of the total face mask for noninvasive ventilation to treat acute respiratory failure. Chest. 2011;1395:1034-1041 [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1. Data after removal of those who discontinued noninvasive ventilation while still requiring ventilatory assistance. ONM=oronasal mask; TFM=total face mask.Grahic Jump Location

Tables

References

Ozsancak A, Sidhom SS, Liesching TN, Howard W, Hill NS. Evaluation of the total face mask for noninvasive ventilation to treat acute respiratory failure. Chest. 2011;1395:1034-1041 [CrossRef] [PubMed]
 
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