Fig. 3.1
Oracle Fisher oral mask
Fig. 3.2
Mouthpiece ventilation. Respironics Mouthpiece Ventilation (MPV) Support System
One study reported that mouthpiece ventilation was used by patients undergoing bronchoscopy [4]. Physiologic parameters consisting of ventilatory parameters, indexes of patients’ respiratory effort, gas exchange, leaks and asynchrony, and comfort were evaluated in another study. The study suggested that a mouthpiece is as effective as a full-face mask in reducing inspiratory effort in both hypoxemic ARF and hypercapnic ARF.
A leak is a significant complication during the mouthpiece ventilation. Levels of leaks were relatively moderate and were lower with the largest mask, being present in 36 % of cases with oronasal masks and 60 % with mouthpiece [5]. A mouthpiece is probably more appropriate for patients with chronic conditions than for patients in respiratory failure.
Mouthpiece ventilation increased pH and lowered paCO2 and prevented endotracheal intubation requirements in patients with respiratory failure due to chronic obstructive respiratory diseases and cardiac insufficiency. Mouthpiece ventilation has also been recommended for the treatment of severe sleep-related breathing disorders [1]. A lip seal or custom orthodontic interface has been used for nocturnal mouthpiece noninvasive positive pressure ventilation.
3.2 Discussion
The most significant benefits of a mouthpiece to support ventilation are less interference with speech, little dead space, better appearance, no necessity of headgear, and, therefore, no possibility of claustrophobia.
The greatest disadvantage is that it is useful predominantly during the daytime except when retained by a lip-covering interface such as Lipseal or Oracle at night [2, 3]. Another disadvantage limiting its use in ARF is nasal leakage, however, mouth air leaks can be controlled with a tight-fitting lip seal and nasal plugs or nose clips can be used to prevent air leak via the nares [3, 6].
Vomit aspiration is a potential complication. In addition, air may be swallowed and cause gastric distention. The advantages and disadvantages of mouthpiece use are summarized in Table 3.1.
Table 3.1
Advantages and disadvantages of mouthpiece use
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