From the Guidelines
A patient should not stay on a nonrebreather mask for an extended period of time for hypoxia because prolonged use can lead to oxygen toxicity and other complications, and guidelines recommend weaning and discontinuation of oxygen therapy once the patient is clinically stable and oxygen saturation is within the desired range 1.
Risks of Prolonged Nonrebreather Mask Use
- Oxygen toxicity: High concentrations of oxygen can damage lung tissue through the formation of reactive oxygen species, worsening respiratory function and potentially leading to absorption atelectasis 1.
- Patient discomfort: Extended use of a nonrebreather mask can cause skin breakdown around the mask seal and dehydration of the respiratory mucosa.
- Inadequate humidification: Nonrebreather masks do not provide adequate humidification, which can lead to dryness and irritation of the respiratory tract.
Recommendations for Oxygen Therapy
- Weaning and discontinuation of oxygen therapy: Once a patient is clinically stable and oxygen saturation is within the desired range, oxygen therapy should be stopped, and the patient should be monitored for 5 minutes after stopping oxygen therapy 1.
- Alternative oxygen delivery methods: For patients requiring extended oxygen therapy, transitioning to alternative oxygen delivery methods such as nasal cannula, Venturi mask, or high-flow nasal cannula is recommended based on their specific oxygen needs 1.
- Monitoring and reassessment: Patients should be monitored regularly, and their oxygen therapy should be reassessed and adjusted as needed to ensure they are receiving the appropriate level of oxygen therapy 1.
From the Research
Risks of Prolonged Nonrebreather Use
- Prolonged use of a nonrebreather mask for hypoxia is not recommended due to the lack of evidence supporting its effectiveness in improving oxygenation and reducing the work of breathing compared to other methods such as high flow nasal cannula (HFNC) or non-invasive ventilation (NIV) 2.
- HFNC produces a higher flow of FiO2, creating a positive pressure on the higher respiratory tract, which can help open collapsed alveoli and eliminate CO2, improving oxygenation and reducing the total work of breathing 2.
- Non-invasive ventilation (NIV) improves ventilation and reduces the work of breathing, and can prevent intubation if initiated early and carefully evaluated 2.
Comparison with Other Oxygen Therapy Methods
- A study comparing non-invasive ventilation and high-flow nasal cannula oxygen therapy for patients with acute hypoxemic respiratory failure found no difference in preventing severe hypoxemia during intubation, but reported higher pulse oximetry values and fewer cases of severe hypoxia in the NIV cohort 3.
- The study suggests that NIV may be more effective in preventing severe hypoxia in patients with moderate-to-severe hypoxemia, but more research is needed to confirm this finding 3.
Potential Complications
- Prolonged use of a nonrebreather mask may not address the underlying causes of hypoxia, and may lead to delayed intubation or other complications such as hypertension, pulmonary aspiration, and increased 30-day mortality 3.