What are the side effects of mask ventilation?
Mask ventilation is generally well tolerated. However, some patients who use mask ventilation may experience discomfort and “side effects” from the ventilation therapy.
The burdens of mask ventilation begin with the use of the device itself. The necessity and “obligation” of daily mask use can be seen as an intrusion into everyday life. From this perspective, adherence to the “ventilation regimen”—which requires daily mask use for as many as eight hours—can be viewed as a restriction on patient autonomy.
Wearing a mask can also be perceived as a burden because it feels like a foreign object. The mask is secured over the nose or mouth with gentle pressure (from wide elastic straps). This fastening can be perceived as a restriction on freedom of movement. Patients with limited hand and arm function cannot put on or take off the mask on their own. This need for assistance from others can be perceived as a further limitation on patient autonomy.
Wearing a mask over the nose, mouth, or entire face alters or restricts speech. The reduction in communication ability while wearing a mask should also be taken into account.
The ventilator includes a compressor that is electrically powered and operates largely silently. However, the airflow generated by the device produces sounds that patients and their family members in the immediate vicinity may find disturbing or, at the very least, take some getting used to. In such situations, sleeping in separate bedrooms may be necessary and can be seen as an intrusion of mask ventilation into daily life.
If the mask is not secured tightly enough over the nose and mouth, airflow may occur between the skin and the mask. This “air leak” (“leakage”) can cause noise or discomfort. For example, air escaping upward can create a draft over the eyelashes and cause more frequent blinking.
Even without leaks, the steady airflow from mask ventilation can cause a dry mouth or irritation of the nasal and throat passages.
In certain ventilator settings (especially when high ventilator pressures are required), some of the airflow may not enter the trachea but instead enter the adjacent esophagus and, from there, the stomach. The entry of ventilated air into the stomach is referred to as “aerophagia” (“swallowed air”). Aerophagia is usually experienced as uncomfortable, as the formation of an air bubble in the stomach can cause a feeling of fullness or even pressure pain. Furthermore, air “refluxes” from the stomach back up through the esophagus into the throat. Aerophagia requires a change in ventilation parameters and an adjustment to mask ventilation.
Several of the mentioned burdens and side effects of mask ventilation can be prevented or reduced by adjusting or changing the ventilation settings. Optimizing ventilation—striking a balance between effective ventilation parameters and minimizing discomfort as much as possible—is at the heart of an adjustment process known as mask ventilation adaptation. Adapting mask ventilation can be challenging and usually requires admission to a “sleep lab” (since the mask is fitted for nighttime use) or to another hospital department that specializes in mask ventilation adaptation.
Despite the wide range of potential side effects and discomforts associated with mask ventilation, this form of ventilation is well tolerated by the majority of patients, so that in most cases the positive aspects of ventilatory therapy (relief from respiratory effort and an improved prognosis) outweigh the negative aspects of mask ventilation (which affect some patients but not all users).