Noninvasive ventilation (NIV) has been recognized as an effective treatment to avoid the need for invasive mechanical ventilation and its associated complications in patients with acute respiratory failure (ARF). Compared with invasive mechanical ventilation, the use of NIV has the advantage of decreasing the risk of ventilator-associated pneumonia, as well as a reduction in the hospital stay and mortality.

NIV has particularly been indicated to treat patients with chronic obstructive pulmonary disease exacerbation, acute cardiogenic pulmonary edema, hypercapnic respiratory failure secondary to chest wall deformity or neuromuscular diseases, pulmonary infection in immunosuppressed subjects, acute pancreatitis, and in weaning from tracheal intubation. However, some complications and injurious effects with the use of NIV have also been identified, such as aerophagia, inefficiency to handle copious secretions, bronchoaspiration, hemodynamic instability, and patient-ventilator asynchrony. Other factors that may limit the use of NIV are interface-related problems such as air leaks and mask intolerance due to claustrophobia and anxiety. The development of facial skin breakdown (SB) in the zones of greatest contact pressure between the mask and the patient’s skin has also been recognized as one of the most serious complications related to the use of an interface in patients with ARF because it can increase the discomfort reported by the patient, resulting in interface intolerance and, consequently, in NIV failure [1]. Therefore, this chapter reviews the classification, frequency, and potential treatment-related risk factors for SB. Early identification of these factors is fundamental to preventing the development of SB, thus providing the best quality of care to patients.