Modified snorkeling facemasks for safe application of non-invasive ventilation. A pilot study

Introduction: within the context of the SARS-CoV-2 pandemic, different authors proposed adaptations to snorkeling masks available in the market (modified masks: MM) to provide oxygen therapy with positive pressure ventilation or not. Until today, none of them has assessed its performance as an interface for non-invasive ventilation (NIV) in the inspiratory pressure support mode. Objective: to develop an interface of NIV using MMand assess its performance with a conventional full mask. Method: the MM were adapted as NIV interfaces using two pieces created by 3D printing. Their performance was compared to a that of a conventional mask in 10 healthy volunteers in inspiratory pressure support (3 cmH(2)O) mode with two levels of positive pressure towards the end of expiration (PEEP 4 and 8 cmH(2)O). The following were compared: system leaks, respiratory rate, normal volume, pulse oximetry, transcutaneous carbon dioxide and comfort. Results: with 4 cmH(2)O of PEEP, no significant differences were found between masks in none of the variables studied. With 8 cmH(2)O de PEEP, the use of MM were associated to a lower level of CO(2)tc (41.0 +/- 5.7 vs 43.5 +/- 8.1 mmHg; p=0.03) and greater comfort (8.3 +/- 1.1 vs 6.5 +/- 1.4; p<0.01) than conventional masks (CM). Conclusions: in healthy volunteers, MM for NIV evidence a similar performance than that of standard oronasal masks, and have a further advantage, as they are more comfortable and cheaper. Even if further studies are needed to support its use, modified snorkeling masks could represent a valid option during the health emergency caused by the SARS-CoV-2 pandemic in consideration of the scarce interfaces available in the market.