{"title":"新型呼吸面罩的开发和功能特性分析:全风琴式缓冲垫可防止无创通气过程中的漏气和压力损伤","authors":"Masahiko Hara, Masatake Tamaki","doi":"10.1186/s13054-024-05133-5","DOIUrl":null,"url":null,"abstract":"<p>Non-invasive ventilation (NIV) is critical in the treatment of several respiratory diseases [1, 2]. However, interface air leakage and resultant pressure injury from tight-fitting can lead to intolerance or unsuccessful implementation of NIV [3, 4]. In response to these challenges, we have developed a new type of oronasal mask with full accordion cushioning designed to achieve effective sealing at lower pressures (Fig. 1 and Video. S1). Our mask incorporates six innovations: full accordion cushioning, turtle shell cover, nasal groove, folding function, visual pressure indicator, and soft medical-grade silicone (Videos. S2, S3, and S4). The mask is tapered toward the face, and it also incorporates multiple elastic adjustment lines to improve adaptability and fit, allowing the mask to “fold” snugly around the face. These elements enhance the mask’s ability to evenly distribute pressure and conform to different facial shapes, providing a secure fit at low pressures. The thickness of the accordion cushion decreases toward the face side, providing a visual indication of pressure application through the compression of the accordion valleys.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05133-5/MediaObjects/13054_2024_5133_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"433\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05133-5/MediaObjects/13054_2024_5133_Fig1_HTML.png\" width=\"685\"/></picture><p>Structural and Functional Features of Our Novel Respiratory Mask with Full Accordion Cushioning. Overview of the mask (<b>A</b>). The rear view of the mask from the face side shows the nasal groove (<b>B</b>). Elastic adjustment lines are symmetrically aligned with six on the nasal side and eight on the chin side (<b>C</b>). An illustration of the mask in clinical use (<b>D</b>). A detailed view of the accordion structure, showing the five outermost ridges defined as accordion lines (<b>E</b>). These ridges are sequentially labeled from the face side (first line, purple) to the cover side (fifth line, blue). Mechanical testing provided visual cues for the estimated pressure at which the mask would adhere to the skin (<b>F</b>). See Video. S1 for the 3-dimensional computer-aided design data of the mask, Video. S2 for a frontal view of the mask in use, Video. S3 for a visualization of the nasal groove, and Video. S4 for the folding function</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>To assess the mask’s performance, a mechanical bench test was conducted to evaluate sealing efficiency and to estimate skin pressure at various visual pressure indicator scenarios. Smoke leak tests were performed to visually confirm the seal (Video. S5). The mask conformed effectively to various mannequin head shapes, and achieved complete sealing at an estimated skin pressure of 2.2 mmHg. The outermost ridges were sequentially labelled from the facial side. Estimated skin pressures were 5.3 ± 0.4 mmHg when the first and second accordion lines adhered, 10.8 ± 0.6 mmHg when the first through third lines adhered, and 16.8 ± 0.7 mmHg when the first through fourth lines adhered. The Lin’s concordance correlation coefficient was 0.987 (95% confidence interval, 0.963–0.995), indicating a high degree of agreement between measurements by different observers. Based on these results, we developed a special strap (Fig. S1) that allows the mask to be held in place on the face with minimal pressure, thereby improving usability. The mask was registered as a medical device in Japan under the product name “javalla” (iDevice, Inc., Osaka, Japan), a term that reflects the accordion-like structure. The mask is designed for reuse, with durability guaranteed for up to 10 patients per mask.</p><p>Initial clinical feedback has been overwhelmingly positive, highlighting the mask’s ease of fit and comfort without the need for specific sizing. The one-size-fits-all design eliminates the need for sizing by conforming to a variety of facial shapes, including different nasal contours. Users reported fewer air leaks, less discomfort, and reduced ventilator alarms. The folding feature benefited patients with edentulous faces or sunken cheeks. During the trial sales phase, 33 out of 74 hospitals (44.6%) adopted our product, despite its price being more than double that of the most commonly used masks available to them. However, some users noted a learning curve for the placement method, concerns about the looser fit, and the importance of keeping the ventilator tube tension-free (gravity-free) to prevent dislodgement due to the soft wearing of the mask. It was also observed that some users tended to secure the mask too tightly, as with conventional masks, resulting in excessive tightening that caused the 1st through 4th accordion lines to adhere. This led to the loss of the cushion’s flexibility, paradoxically increasing air leaks rather than preventing it.</p><p>This novel mask addresses critical challenges in NIV, such as air leak and pressure injury, which are often associated with high morbidity and increased healthcare costs [3, 4]. Pressure injuries occur when the sustained external force exceeds tissue perfusion pressure, typically around 30–35 mmHg [4, 5]. Our mask’s ability to provide an effective seal at low pressures shows potential in reducing the occurrence of these injuries. Preliminary testing suggests that the mask achieves an optimal balance between comfort and sealing efficacy when fitted to engage the first two to three accordion lines, maintaining pressures well below the injury threshold [4, 5]. The mask’s ease of fitting and elimination of sizing requirements could also reduce the time needed to implement NIV, particularly in emergency settings. As with any novel device, widespread clinical use and further studies are necessary to determine the long-term impact of the mask on clinical outcomes, including the prevention of pressure injuries and improving patient tolerance during NIV. In conclusion, we have developed a novel oronasal mask with full accordion cushioning to address air leakage, pressure discomfort, and pressure injury during NIV. Bench testing demonstrated effective sealing at lower pressures. Clinical studies are warranted to evaluate the impact of the mask on clinical outcomes.</p><p>The data and materials used in this study are available from the corresponding author upon reasonable request.</p><dl><dt style=\"min-width:50px;\"><dfn>NIV:</dfn></dt><dd>\n<p>Non-invasive ventilation</p>\n</dd></dl><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7:CD004104.</p><p>PubMed Google Scholar </p></li><li data-counter=\"2.\"><p>Berbenetz N, Wang Y, Brown J, Godfrey C, Ahmad M, Vital FM, Lambiase P, Banerjee A, Bakhai A, Chong M. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2019;4:CD005351.</p><p>PubMed Google Scholar </p></li><li data-counter=\"3.\"><p>Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003;124:699–713.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"4.\"><p>Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA. 2006;296:974–84.</p><p>Article CAS PubMed Google Scholar </p></li><li data-counter=\"5.\"><p>Thomas DR. Does pressure cause pressure ulcers? An inquiry into the etiology of pressure ulcers. J Am Med Dir Assoc. 2010;11:397–405.</p><p>Article PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>The authors thank the Japan Society of Clinical Research for their dedicated support.</p><p>None.</p><h3>Authors and Affiliations</h3><ol><li><p>Department of Medical Device Development, iDevice, Inc., Osaka, Japan</p><p>Masahiko Hara & Masatake Tamaki</p></li><li><p>Center for Community-Based Healthcare Research and Education, Shimane University Faculty of Medicine, Izumo, Japan</p><p>Masahiko Hara</p></li></ol><span>Authors</span><ol><li><span>Masahiko Hara</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Masatake Tamaki</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>MH and MT contributed to the conception and design of this manuscript, the acquisition and interpretation of data, and the drafting and revision of the manuscript for critical intellectual content.</p><h3>Corresponding author</h3><p>Correspondence to Masahiko Hara.</p><h3>Ethics approval and consent to participate</h3>\n<p>The need for approval was waived because this is not an article of clinical study.</p>\n<h3>Consent for publication</h3>\n<p>Not applicable.</p>\n<h3>Competing interests</h3>\n<p>All authors are shareholders and serve as board members of iDevice, Inc.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p>We herewith state that (1) the paper is not under consideration elsewhere, (2) the paper’s contents have not been previously published in whole or in part, (3) all authors have read and approved the manuscript, and (4) all authors are shareholders and serve as board members of iDevice, Inc. Additionally, iDevice holds four patents related to the product discussed in this manuscript.</p><h3>Additional file 1. Supplementary Figure 1. Demonstration of the Mask Fitting Process.</h3><script src=\"//e.video-cdn.net/v2/embed.js\"></script><p>Additional file 2. Supplementary Video 1. Three-Dimensional Computer-Aided Design Visualization of Our Novel Respiratory Mask with Full Accordion Cushioning.</p><script src=\"//e.video-cdn.net/v2/embed.js\"></script><p>Additional file 3. Supplementary Video 2. How The Full Accordion Cushioning Conforms to The FACE.</p><script src=\"//e.video-cdn.net/v2/embed.js\"></script><p>Additional file 4. Supplementary Video 3. How The Nasal Groove Conforms to The FACE.</p><script src=\"//e.video-cdn.net/v2/embed.js\"></script><p>Additional file 5. Supplementary Video 4. The Folding Function in Action.</p><script src=\"//e.video-cdn.net/v2/embed.js\"></script><p>Additional file 6. Supplementary Video 5. Smoke-Based Air Leakage Assessment of The Mask.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>\" width=\"57\"/><h3>Cite this article</h3><p>Hara, M., Tamaki, M. Development and functional characterization of a novel respiratory mask with full accordion cushioning to prevent air leaks and pressure injuries during non-invasive ventilation. <i>Crit Care</i> <b>28</b>, 353 (2024). https://doi.org/10.1186/s13054-024-05133-5</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2024-10-13\">13 October 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2024-10-15\">15 October 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2024-11-01\">01 November 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05133-5</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\"click\" data-track-action=\"get shareable link\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\"click\" data-track-action=\"select share url\" data-track-label=\"button\"></p><button data-track=\"click\" data-track-action=\"copy share url\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Development and functional characterization of a novel respiratory mask with full accordion cushioning to prevent air leaks and pressure injuries during non-invasive ventilation\",\"authors\":\"Masahiko Hara, Masatake Tamaki\",\"doi\":\"10.1186/s13054-024-05133-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Non-invasive ventilation (NIV) is critical in the treatment of several respiratory diseases [1, 2]. However, interface air leakage and resultant pressure injury from tight-fitting can lead to intolerance or unsuccessful implementation of NIV [3, 4]. In response to these challenges, we have developed a new type of oronasal mask with full accordion cushioning designed to achieve effective sealing at lower pressures (Fig. 1 and Video. S1). Our mask incorporates six innovations: full accordion cushioning, turtle shell cover, nasal groove, folding function, visual pressure indicator, and soft medical-grade silicone (Videos. S2, S3, and S4). The mask is tapered toward the face, and it also incorporates multiple elastic adjustment lines to improve adaptability and fit, allowing the mask to “fold” snugly around the face. These elements enhance the mask’s ability to evenly distribute pressure and conform to different facial shapes, providing a secure fit at low pressures. The thickness of the accordion cushion decreases toward the face side, providing a visual indication of pressure application through the compression of the accordion valleys.</p><figure><figcaption><b data-test=\\\"figure-caption-text\\\">Fig. 1</b></figcaption><picture><source srcset=\\\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05133-5/MediaObjects/13054_2024_5133_Fig1_HTML.png?as=webp\\\" type=\\\"image/webp\\\"/><img alt=\\\"figure 1\\\" aria-describedby=\\\"Fig1\\\" height=\\\"433\\\" loading=\\\"lazy\\\" src=\\\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05133-5/MediaObjects/13054_2024_5133_Fig1_HTML.png\\\" width=\\\"685\\\"/></picture><p>Structural and Functional Features of Our Novel Respiratory Mask with Full Accordion Cushioning. Overview of the mask (<b>A</b>). The rear view of the mask from the face side shows the nasal groove (<b>B</b>). Elastic adjustment lines are symmetrically aligned with six on the nasal side and eight on the chin side (<b>C</b>). An illustration of the mask in clinical use (<b>D</b>). A detailed view of the accordion structure, showing the five outermost ridges defined as accordion lines (<b>E</b>). These ridges are sequentially labeled from the face side (first line, purple) to the cover side (fifth line, blue). Mechanical testing provided visual cues for the estimated pressure at which the mask would adhere to the skin (<b>F</b>). See Video. S1 for the 3-dimensional computer-aided design data of the mask, Video. S2 for a frontal view of the mask in use, Video. S3 for a visualization of the nasal groove, and Video. S4 for the folding function</p><span>Full size image</span><svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-chevron-right-small\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></figure><p>To assess the mask’s performance, a mechanical bench test was conducted to evaluate sealing efficiency and to estimate skin pressure at various visual pressure indicator scenarios. Smoke leak tests were performed to visually confirm the seal (Video. S5). The mask conformed effectively to various mannequin head shapes, and achieved complete sealing at an estimated skin pressure of 2.2 mmHg. The outermost ridges were sequentially labelled from the facial side. Estimated skin pressures were 5.3 ± 0.4 mmHg when the first and second accordion lines adhered, 10.8 ± 0.6 mmHg when the first through third lines adhered, and 16.8 ± 0.7 mmHg when the first through fourth lines adhered. The Lin’s concordance correlation coefficient was 0.987 (95% confidence interval, 0.963–0.995), indicating a high degree of agreement between measurements by different observers. Based on these results, we developed a special strap (Fig. S1) that allows the mask to be held in place on the face with minimal pressure, thereby improving usability. The mask was registered as a medical device in Japan under the product name “javalla” (iDevice, Inc., Osaka, Japan), a term that reflects the accordion-like structure. The mask is designed for reuse, with durability guaranteed for up to 10 patients per mask.</p><p>Initial clinical feedback has been overwhelmingly positive, highlighting the mask’s ease of fit and comfort without the need for specific sizing. The one-size-fits-all design eliminates the need for sizing by conforming to a variety of facial shapes, including different nasal contours. Users reported fewer air leaks, less discomfort, and reduced ventilator alarms. The folding feature benefited patients with edentulous faces or sunken cheeks. During the trial sales phase, 33 out of 74 hospitals (44.6%) adopted our product, despite its price being more than double that of the most commonly used masks available to them. However, some users noted a learning curve for the placement method, concerns about the looser fit, and the importance of keeping the ventilator tube tension-free (gravity-free) to prevent dislodgement due to the soft wearing of the mask. It was also observed that some users tended to secure the mask too tightly, as with conventional masks, resulting in excessive tightening that caused the 1st through 4th accordion lines to adhere. This led to the loss of the cushion’s flexibility, paradoxically increasing air leaks rather than preventing it.</p><p>This novel mask addresses critical challenges in NIV, such as air leak and pressure injury, which are often associated with high morbidity and increased healthcare costs [3, 4]. Pressure injuries occur when the sustained external force exceeds tissue perfusion pressure, typically around 30–35 mmHg [4, 5]. Our mask’s ability to provide an effective seal at low pressures shows potential in reducing the occurrence of these injuries. Preliminary testing suggests that the mask achieves an optimal balance between comfort and sealing efficacy when fitted to engage the first two to three accordion lines, maintaining pressures well below the injury threshold [4, 5]. The mask’s ease of fitting and elimination of sizing requirements could also reduce the time needed to implement NIV, particularly in emergency settings. As with any novel device, widespread clinical use and further studies are necessary to determine the long-term impact of the mask on clinical outcomes, including the prevention of pressure injuries and improving patient tolerance during NIV. In conclusion, we have developed a novel oronasal mask with full accordion cushioning to address air leakage, pressure discomfort, and pressure injury during NIV. Bench testing demonstrated effective sealing at lower pressures. Clinical studies are warranted to evaluate the impact of the mask on clinical outcomes.</p><p>The data and materials used in this study are available from the corresponding author upon reasonable request.</p><dl><dt style=\\\"min-width:50px;\\\"><dfn>NIV:</dfn></dt><dd>\\n<p>Non-invasive ventilation</p>\\n</dd></dl><ol data-track-component=\\\"outbound reference\\\" data-track-context=\\\"references section\\\"><li data-counter=\\\"1.\\\"><p>Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7:CD004104.</p><p>PubMed Google Scholar </p></li><li data-counter=\\\"2.\\\"><p>Berbenetz N, Wang Y, Brown J, Godfrey C, Ahmad M, Vital FM, Lambiase P, Banerjee A, Bakhai A, Chong M. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2019;4:CD005351.</p><p>PubMed Google Scholar </p></li><li data-counter=\\\"3.\\\"><p>Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003;124:699–713.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\\\"4.\\\"><p>Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA. 2006;296:974–84.</p><p>Article CAS PubMed Google Scholar </p></li><li data-counter=\\\"5.\\\"><p>Thomas DR. Does pressure cause pressure ulcers? An inquiry into the etiology of pressure ulcers. J Am Med Dir Assoc. 2010;11:397–405.</p><p>Article PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-download-medium\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></p><p>The authors thank the Japan Society of Clinical Research for their dedicated support.</p><p>None.</p><h3>Authors and Affiliations</h3><ol><li><p>Department of Medical Device Development, iDevice, Inc., Osaka, Japan</p><p>Masahiko Hara & Masatake Tamaki</p></li><li><p>Center for Community-Based Healthcare Research and Education, Shimane University Faculty of Medicine, Izumo, Japan</p><p>Masahiko Hara</p></li></ol><span>Authors</span><ol><li><span>Masahiko Hara</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Masatake Tamaki</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>MH and MT contributed to the conception and design of this manuscript, the acquisition and interpretation of data, and the drafting and revision of the manuscript for critical intellectual content.</p><h3>Corresponding author</h3><p>Correspondence to Masahiko Hara.</p><h3>Ethics approval and consent to participate</h3>\\n<p>The need for approval was waived because this is not an article of clinical study.</p>\\n<h3>Consent for publication</h3>\\n<p>Not applicable.</p>\\n<h3>Competing interests</h3>\\n<p>All authors are shareholders and serve as board members of iDevice, Inc.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p>We herewith state that (1) the paper is not under consideration elsewhere, (2) the paper’s contents have not been previously published in whole or in part, (3) all authors have read and approved the manuscript, and (4) all authors are shareholders and serve as board members of iDevice, Inc. Additionally, iDevice holds four patents related to the product discussed in this manuscript.</p><h3>Additional file 1. Supplementary Figure 1. Demonstration of the Mask Fitting Process.</h3><script src=\\\"//e.video-cdn.net/v2/embed.js\\\"></script><p>Additional file 2. Supplementary Video 1. Three-Dimensional Computer-Aided Design Visualization of Our Novel Respiratory Mask with Full Accordion Cushioning.</p><script src=\\\"//e.video-cdn.net/v2/embed.js\\\"></script><p>Additional file 3. Supplementary Video 2. How The Full Accordion Cushioning Conforms to The FACE.</p><script src=\\\"//e.video-cdn.net/v2/embed.js\\\"></script><p>Additional file 4. Supplementary Video 3. How The Nasal Groove Conforms to The FACE.</p><script src=\\\"//e.video-cdn.net/v2/embed.js\\\"></script><p>Additional file 5. Supplementary Video 4. The Folding Function in Action.</p><script src=\\\"//e.video-cdn.net/v2/embed.js\\\"></script><p>Additional file 6. Supplementary Video 5. Smoke-Based Air Leakage Assessment of The Mask.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.</p>\\n<p>Reprints and permissions</p><img alt=\\\"Check for updates. 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Development and functional characterization of a novel respiratory mask with full accordion cushioning to prevent air leaks and pressure injuries during non-invasive ventilation. <i>Crit Care</i> <b>28</b>, 353 (2024). https://doi.org/10.1186/s13054-024-05133-5</p><p>Download citation<svg aria-hidden=\\\"true\\\" focusable=\\\"false\\\" height=\\\"16\\\" role=\\\"img\\\" width=\\\"16\\\"><use xlink:href=\\\"#icon-eds-i-download-medium\\\" xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\"></use></svg></p><ul data-test=\\\"publication-history\\\"><li><p>Received<span>: </span><span><time datetime=\\\"2024-10-13\\\">13 October 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\\\"2024-10-15\\\">15 October 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\\\"2024-11-01\\\">01 November 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05133-5</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\\\"click\\\" data-track-action=\\\"get shareable link\\\" data-track-external=\\\"\\\" data-track-label=\\\"button\\\" type=\\\"button\\\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\\\"click\\\" data-track-action=\\\"select share url\\\" data-track-label=\\\"button\\\"></p><button data-track=\\\"click\\\" data-track-action=\\\"copy share url\\\" data-track-external=\\\"\\\" data-track-label=\\\"button\\\" type=\\\"button\\\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>\",\"PeriodicalId\":10811,\"journal\":{\"name\":\"Critical Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":8.8000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13054-024-05133-5\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13054-024-05133-5","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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摘要
无创通气(NIV)是治疗多种呼吸系统疾病的关键[1, 2]。然而,界面漏气和紧身佩戴造成的压力损伤会导致患者不耐受或无法成功实施 NIV [3,4]。为了应对这些挑战,我们开发了一种新型口鼻面罩,其全风琴式缓冲设计可在较低压力下实现有效密封(图 1 和视频 S1)。我们的喉罩采用了六项创新技术:全风琴式缓冲、龟甲盖、鼻槽、折叠功能、可视压力指示器和医用软硅胶(视频 S2、S3 和 S4)。面罩朝向脸部呈锥形,还包含多条弹性调节线,以提高适应性和贴合度,使面罩能紧贴脸部 "折叠"。这些元素增强了面罩均匀分布压力和适应不同脸型的能力,在低压下也能提供安全的贴合。风琴式缓冲垫的厚度向脸部一侧减小,通过压缩风琴式凹谷提供压力应用的视觉指示。面罩概览(A)。从面罩背面看,可以看到鼻腔凹槽 (B)。弹性调节线对称排列,鼻侧六条,下巴侧八条(C)。面罩临床使用示意图(D)。手风琴结构的详细视图,显示最外侧的五条脊线被定义为手风琴线(E)。这些脊线从面部(第一条线,紫色)到盖面(第五条线,蓝色)依次标注。机械测试为面罩附着在皮肤上的估计压力提供了视觉提示(F)。参见视频。S1 为面具的三维计算机辅助设计数据,视频.S2 为面罩使用时的正面视图,视频.S3 为鼻槽的可视化,视频为评估面罩的性能,进行了机械台架测试,以评估密封效率,并估算各种视觉压力指示器情况下的皮肤压力。还进行了烟雾泄漏测试,以直观地确认密封性(视频 S5)。面罩能有效贴合各种人体模型的头部形状,并在估计皮肤压力为 2.2 mmHg 时实现完全密封。最外侧的脊线从面部开始依次标注。当第一条和第二条风琴线粘合时,估计皮肤压力为 5.3 ± 0.4 mmHg;当第一条至第三条线粘合时,估计皮肤压力为 10.8 ± 0.6 mmHg;当第一条至第四条线粘合时,估计皮肤压力为 16.8 ± 0.7 mmHg。林氏一致性相关系数为 0.987(95% 置信区间,0.963-0.995),表明不同观察者的测量结果高度一致。根据这些结果,我们开发了一种特殊的绑带(图 S1),可使面罩以最小的压力固定在面部,从而提高了可用性。该面罩在日本注册为医疗设备,产品名称为 "javalla"(iDevice, Inc.,日本大阪)。面罩的设计可重复使用,每个面罩最多可保证为 10 名患者提供耐用性。最初的临床反馈非常积极,强调了面罩的易贴合性和舒适性,而无需特定尺寸。一刀切的设计符合各种脸型,包括不同的鼻部轮廓,因此无需调整尺寸。用户反映漏气较少,不适感减轻,呼吸机报警减少。折叠功能使脸部无齿或脸颊凹陷的患者受益匪浅。在试销阶段,74 家医院中有 33 家(44.6%)采用了我们的产品,尽管其价格比他们最常用的面罩高出一倍多。然而,一些用户指出,他们需要学习如何放置面罩,担心面罩较松,以及保持呼吸机管道无张力(无重力)的重要性,以防止因面罩佩戴过软而脱落。此外,还观察到一些使用者倾向于将面罩固定得太紧,就像传统面罩一样,导致过度收紧,造成第 1 至第 4 条风琴线粘连。这种新型喉罩解决了 NIV 面临的关键挑战,如漏气和压力损伤,这往往与高发病率和医疗成本增加有关 [3,4]。当持续外力超过组织灌注压力(通常约为 30-35 mmHg)时,就会发生压力损伤[4, 5]。我们的面罩能够在低压下提供有效的密封,这表明它具有减少此类伤害发生的潜力。 如果文章的知识共享许可中没有包含材料,而您的使用意图又不符合法律规定或超出了许可使用范围,您需要直接从版权所有者处获得许可。要查看此许可的副本,请访问 http://creativecommons.org/licenses/by/4.0/.Reprints and permissionsCite this articleHara, M., Tamaki, M. Development and functional characterization of a novel respiratory mask with full accordion cushion to prevent air leaks and pressure injuries during non-invasive ventilation.https://doi.org/10.1186/s13054-024-05133-5Download citationReceived:13 October 2024Accepted:15 October 2024Published: 01 November 2024DOI: https://doi.org/10.1186/s13054-024-05133-5Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative.
Development and functional characterization of a novel respiratory mask with full accordion cushioning to prevent air leaks and pressure injuries during non-invasive ventilation
Non-invasive ventilation (NIV) is critical in the treatment of several respiratory diseases [1, 2]. However, interface air leakage and resultant pressure injury from tight-fitting can lead to intolerance or unsuccessful implementation of NIV [3, 4]. In response to these challenges, we have developed a new type of oronasal mask with full accordion cushioning designed to achieve effective sealing at lower pressures (Fig. 1 and Video. S1). Our mask incorporates six innovations: full accordion cushioning, turtle shell cover, nasal groove, folding function, visual pressure indicator, and soft medical-grade silicone (Videos. S2, S3, and S4). The mask is tapered toward the face, and it also incorporates multiple elastic adjustment lines to improve adaptability and fit, allowing the mask to “fold” snugly around the face. These elements enhance the mask’s ability to evenly distribute pressure and conform to different facial shapes, providing a secure fit at low pressures. The thickness of the accordion cushion decreases toward the face side, providing a visual indication of pressure application through the compression of the accordion valleys.
To assess the mask’s performance, a mechanical bench test was conducted to evaluate sealing efficiency and to estimate skin pressure at various visual pressure indicator scenarios. Smoke leak tests were performed to visually confirm the seal (Video. S5). The mask conformed effectively to various mannequin head shapes, and achieved complete sealing at an estimated skin pressure of 2.2 mmHg. The outermost ridges were sequentially labelled from the facial side. Estimated skin pressures were 5.3 ± 0.4 mmHg when the first and second accordion lines adhered, 10.8 ± 0.6 mmHg when the first through third lines adhered, and 16.8 ± 0.7 mmHg when the first through fourth lines adhered. The Lin’s concordance correlation coefficient was 0.987 (95% confidence interval, 0.963–0.995), indicating a high degree of agreement between measurements by different observers. Based on these results, we developed a special strap (Fig. S1) that allows the mask to be held in place on the face with minimal pressure, thereby improving usability. The mask was registered as a medical device in Japan under the product name “javalla” (iDevice, Inc., Osaka, Japan), a term that reflects the accordion-like structure. The mask is designed for reuse, with durability guaranteed for up to 10 patients per mask.
Initial clinical feedback has been overwhelmingly positive, highlighting the mask’s ease of fit and comfort without the need for specific sizing. The one-size-fits-all design eliminates the need for sizing by conforming to a variety of facial shapes, including different nasal contours. Users reported fewer air leaks, less discomfort, and reduced ventilator alarms. The folding feature benefited patients with edentulous faces or sunken cheeks. During the trial sales phase, 33 out of 74 hospitals (44.6%) adopted our product, despite its price being more than double that of the most commonly used masks available to them. However, some users noted a learning curve for the placement method, concerns about the looser fit, and the importance of keeping the ventilator tube tension-free (gravity-free) to prevent dislodgement due to the soft wearing of the mask. It was also observed that some users tended to secure the mask too tightly, as with conventional masks, resulting in excessive tightening that caused the 1st through 4th accordion lines to adhere. This led to the loss of the cushion’s flexibility, paradoxically increasing air leaks rather than preventing it.
This novel mask addresses critical challenges in NIV, such as air leak and pressure injury, which are often associated with high morbidity and increased healthcare costs [3, 4]. Pressure injuries occur when the sustained external force exceeds tissue perfusion pressure, typically around 30–35 mmHg [4, 5]. Our mask’s ability to provide an effective seal at low pressures shows potential in reducing the occurrence of these injuries. Preliminary testing suggests that the mask achieves an optimal balance between comfort and sealing efficacy when fitted to engage the first two to three accordion lines, maintaining pressures well below the injury threshold [4, 5]. The mask’s ease of fitting and elimination of sizing requirements could also reduce the time needed to implement NIV, particularly in emergency settings. As with any novel device, widespread clinical use and further studies are necessary to determine the long-term impact of the mask on clinical outcomes, including the prevention of pressure injuries and improving patient tolerance during NIV. In conclusion, we have developed a novel oronasal mask with full accordion cushioning to address air leakage, pressure discomfort, and pressure injury during NIV. Bench testing demonstrated effective sealing at lower pressures. Clinical studies are warranted to evaluate the impact of the mask on clinical outcomes.
The data and materials used in this study are available from the corresponding author upon reasonable request.
NIV:
Non-invasive ventilation
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The authors thank the Japan Society of Clinical Research for their dedicated support.
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Authors and Affiliations
Department of Medical Device Development, iDevice, Inc., Osaka, Japan
Masahiko Hara & Masatake Tamaki
Center for Community-Based Healthcare Research and Education, Shimane University Faculty of Medicine, Izumo, Japan
Masahiko Hara
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MH and MT contributed to the conception and design of this manuscript, the acquisition and interpretation of data, and the drafting and revision of the manuscript for critical intellectual content.
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Correspondence to Masahiko Hara.
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All authors are shareholders and serve as board members of iDevice, Inc.
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We herewith state that (1) the paper is not under consideration elsewhere, (2) the paper’s contents have not been previously published in whole or in part, (3) all authors have read and approved the manuscript, and (4) all authors are shareholders and serve as board members of iDevice, Inc. Additionally, iDevice holds four patents related to the product discussed in this manuscript.
Additional file 1. Supplementary Figure 1. Demonstration of the Mask Fitting Process.
Additional file 2. Supplementary Video 1. Three-Dimensional Computer-Aided Design Visualization of Our Novel Respiratory Mask with Full Accordion Cushioning.
Additional file 3. Supplementary Video 2. How The Full Accordion Cushioning Conforms to The FACE.
Additional file 4. Supplementary Video 3. How The Nasal Groove Conforms to The FACE.
Additional file 5. Supplementary Video 4. The Folding Function in Action.
Additional file 6. Supplementary Video 5. Smoke-Based Air Leakage Assessment of The Mask.
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Hara, M., Tamaki, M. Development and functional characterization of a novel respiratory mask with full accordion cushioning to prevent air leaks and pressure injuries during non-invasive ventilation. Crit Care28, 353 (2024). https://doi.org/10.1186/s13054-024-05133-5
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Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.