Ventilator-Assisted Living©

Summer 2005, Vol. 19, No. 2


Masks: Obtaining a Good Fit, Part I

Diana Guth, RRT, Owner, Home Respiratory Care, Los Angeles, California (

To obtain a comfortable and well-fitting mask and successfully use noninvasive positive airway pressure (PAP) ventilation, you and the respiratory therapist (RT) at your home health company need to establish a trusting relationship.

The RT should start with an interview to determine your history of breath-ing problems and needs, followed by an examination to determine your manual dexterity, ability to raise your arms to your head, and other physical limitations.

By answering the following questions, you can help the RT choose the best mask for you.

The answers to these questions will help your RT better understand the severity of your breathing problems and help the RT make an informed choice on which mask would work best for you.

If you have questions about wearing a mask, please ask the RT to review the information and selection with you and your spouse/partner/caregiver. It is not uncommon to have anxieties about using a mask: be honest in expressing them to your RT.

The next step is determining what type of nose bridge you have and your nose length and width. Nose bridge analysis is critical in ensuring a leak-free seal without undue pressure on the nose bridge. (Historically, this small area has been the greatest cause of failure in fitting masks.) An effective seal is necessary to prevent air leakage into the eyes (which can cause eye irritation or damage) but the seal should not be so tight that it causes serious nose bridge ulcers and other skin irritation.

To determine nose length and thus the correct mask size, the RT should measure from the top of the nose bridge to under the nose. Nose width is mainly assessed by visual inspection. There are mask gauges and calipers available to help RTs determine mask size, but experience is the best aid.

In finding and fitting the best mask for you, the RT should offer a comprehensive selection of masks, in a variety of sizes, from various manufacturers.

In an ideal world, the fitting should be done at the home health care company’s office in a private room that is designated for that purpose. To properly test the masks, the room should have a bed and pillows so that you can lie down in the position in which you are accustomed to sleeping.

Even the most skilled RT cannot predict the success of the fitting without following up after you have used the mask for a few nights. If the treatment is going well, you can report to the RT again in a week, then in a month, and periodically after that.

If you have a problem with the mask, you need to tell the RT so that he or she can review how the mask (and the PAP device) is working, make the necessary adjustment, or, if necessary, select and fit a different mask.

Adapted from an article in Home Health Dealer/Provider, May 2005.

Part II will discuss the kinds of masks, headgear and chinstraps.

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