Intraoral ulcer due to non-invasive positive pressure ventilation: an overlooked complication

Description

A male patient aged 81 years reported with dyspnoea and loss of consciousness, at our emergency department. His respiratory rate was 30 breaths/min, and his level of consciousness determined using the Glasgow Coma Scale was eye (1), verbal (1) and motor (4). Despite oxygen administration via a bag valve mask, his percutaneous oxygen saturation level was measured as only 81%. Physical examination revealed weak vesicular sound on auscultation, suggesting he had severe emphysema. Arterial blood gas analysis after continuous bag valve mask ventilation revealed pH 7.014, undetectably high pCO₂ and pO₂ of 89 tor. The patient was admitted with the diagnosis with acute exacerbation of chronic obstructive pulmonary disease (COPD). Insufficient spontaneous breathing required installation of mask-type non-invasive positive pressure ventilation (NIPPV: FiO₂, 0.35, IPAP, 10 cm H₂O, EPAP, 3 cm H₂O). After continuous NIPPV support for 8 days, an intraoral ulcer was detected on the patient's lower lip (figure 1)....

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