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Respir Care. 2019 Dec;64(12):1455-1460. doi: 10.4187/respcare.06784. Epub 2019 Jul 23.

Noninvasive Ventilation Device-Related Pressure Injury in a Children's Hospital.

Author information

Department of Respiratory Therapy, Rady Children's Hospital-San Diego, San Diego, California.
Division of Respiratory Medicine, Rady Children's Hospital-San Diego, University of California-San Diego, San Diego, California.
Statistical Analysis of Data, Clinical and Translational Research Institute, University of California-San Diego, San Diego, California.
Department of Nursing, Rady Children's Hospital-San Diego, San Diego, California.
Department of Respiratory Care, Rady Children's Hospital-San Diego, San Diego, California.



Noninvasive ventilation (NIV) contributes to the development of pressure injury in a significant number of hospitalized patients. Pressure injuries contribute to increased length of hospital stay, pain, infection, and disfigurement. This study examined the relationship between NIV use and pressure injuries in hospitalized subjects.


We retrospectively reviewed all patients on NIV at a tertiary-care children's hospital over a 2-y period. We studied the relationship between the characteristics of NIV use and measures of pressure injury severity.


A total of 255 subjects, mean ± SD age 11.3 ± 5.8 y with 343 episodes of NIV use were evaluated, 7.2% (25/343) of which were associated with pressure injury. In univariate analysis, the presence of pressure injury was associated with older age (P = .01), maximum leak (P = .01), 95th percentile leak (P = .01), the log duration of time on NIV until pressure injury formation (P = .01), and maximum inspiratory positive airway pressure level (P = .01). Maximum leak remained statistically significant after multivariable analysis.


After multivariate analysis, only high mask leak was significantly associated with developing a pressure injury. Identifying risk factors that correlate with NIV device-related hospital acquired pressure injuries in children can direct procedures to prevent pressure injury in hospitalized children at high risk.


device-related pressure injury; hospitals; injury; noninvasive ventilation; pediatrics; pressure injury; pressure ulcer; respiratory device; skin


Conflict of interest statement

The authors have disclosed no conflicts of interest.

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