To assess risk of skin pressure lesions in patients treated with noninvasive mechanical ventilation.

Noninvasive ventilation improves the outcome of patients with acute respiratory failure; however patient's discomfort may be responsible for up to a fifth of failures. Scant literature exists on NIV-related pressure ulcers and their determinants.

Aim of the study is to seek for determinants, if any, associated with the development of pressure ulcers related to noninvasive ventilation.

Study design: observational. Patients treated with NIV from December 2009 to December 2011 will be analyzed. Main end-points: to seek for variables associated to the development of NIV-related pressure ulcers in patients with acute respiratory failure.

Inclusion Criteria:

• severe dyspnea at rest
• respiratory rate > 30 per minute
• PaO2/FiO2 < 200 (despite oxygen with Venturi with a FiO2 og 0.5)
• use of accessory respiratory muscles
• pH < 7.35 > 7.10

Exclusion Criteria:

• STEMI
• NSTEMI/Unstable angina
• Hemodynamic instability
• Need for immediate endotracheal intubation
• Inability to protect the airways
• Impaired sensorium
• Pulmonary embolism
• Gastrointestinal bleeding
• Hematological malignancy or neoplasms with ECOG performance status > 2

Patients admitted to our high dependency unit for an episode of acute respiratory failure and treated with noninvasive ventilation.