How long can mask ventilation be performed?

Mask ventilation is initiated when respiratory distress (dyspnea) is present or when respiratory tests indicate a decrease in respiratory function (vital capacity below 70%). Mask ventilation is initially administered for eight hours per 24-hour period and may be increased in duration as the disease progresses. If necessary, mask ventilation can be extended to cover the entire day.

Two factors are critical: The first concern is potential pressure sores (decubitus ulcers) that can develop on the skin—particularly on the nose and cheekbones—with prolonged use of the mask. To ensure effective ventilation, the mask must be pulled quite tightly (using elastic straps) over the nose, over the mouth, or over the entire face. This sustained pressure can cause skin damage. The risk of pressure ulcers is exacerbated by the heat and moisture that build up between the skin and the plastic surface of the mask. To prevent skin lesions, it is therefore recommended to remove the mask periodically. Furthermore, the risk of pressure ulcers can be reduced by having a custom-made mask created (a breathing mask molded from an individual facial impression).

A second limitation of mask ventilation lies in the capabilities of the ventilation method itself. Unlike invasive ventilation via a tracheostomy, mask ventilation is not capable of fully taking over the body’s respiratory function. When mask ventilation reaches its methodological limits, a fundamental decision must be made: between performing a tracheostomy and initiating invasive ventilation on the one hand, or providing palliative care on the other, which focuses on alleviating distressing symptoms (particularly respiratory distress) through palliative medications. Palliative care is provided to 85–95% of all patients in Germany (with regional variations).

Invasive ventilation via a tracheostomy is the appropriate form of care for some patients. The fundamental decision between invasive and palliative treatment should be prepared, made, and documented as part of a long-term consultation and decision-making process involving dialogue between the physician and the patient.