Intervention description {11a}
sores
PRESSURE SORE, PRESSURE ULCER, PRESSURE SORES, RECRUITMENT, PRESSURE ULCER, PRESSURE INJURY, PRESSURE SORE
In the control group, mask will be chosen among the three types of masks available: oronasal, total face, or hybrid mask, according to the standard of care of the participating centers. Patients wearing oronasal masks will receive protective dressing on their nasal bridges before starting NIV. Interface will be changed in case of discomfort, referred by the patient as unbearable, or in the presence of a pressure sore.In the intervention group, the mask initially applied to the patient will be randomly chosen between the two most used masks in that center among those available (i.e., oronasal, total face, or hybrid mask). Thereafter, NIV mask will be changed every 6 h, alternating the two different interfaces. Patients wearing oronasal masks will receive a protective dressing on the nasal bridge before starting NIV. In case of discomfort, referred by the patient as unbearable related to one of the two interfaces, NIV will be continued with the other mask.In both arms, the treatment will be continued until patients require NIV according to the assigned protocol.Prior to patient recruitment, the candidate assessors (doctors and nurses) will be trained to recognize and stage pressure sores through a specific standardized education module. At the end of this course, the trainees will be asked to take a final test where they have to correctly stage 10 pressure sores. Only those trainees able to identify and stage all 10 sores will be qualified as assessors. To minimize detection bias, assessors will not participate in patient care and will be blinded to treatment allocation.The skin underneath the mask and occipital region will be inspected every 12 h for possible damage by the assessors. If a pressure sore is detected, the physician in charge of the patient will be promptly informed, and a note will be written on the nursing record. Pressure sores will be staged according to the classification of the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance [Pressure sores classification according to the classification of the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury AllianceDiscomfort due to the mask will be evaluated every 12 h using a 5-level Likert-like scale [In both groups, in case of the presence of a new pressure ulcer, the strategy that can be applied comprehend (1) application of a wound care dressing or a different kind of wound care dressing; (2) reduction of the time spent on NIV; and (3) change interface.