References

The evidence base

Selected peer-reviewed literature on the efficacy of nasal-route ventilation and the recognized predictors of difficult mask ventilation.

Nasal mask ventilation

Controlled studies comparing nasal-route ventilation with face-mask and combined oral–nasal ventilation.

  1. Continuous positive airway pressure and ventilation are more effective with a nasal mask than a full face mask in unconscious subjects: a randomized controlled trial
  2. Effectiveness of Breathing through Nasal and Oral Routes in Unconscious Apneic Adult Human Subjects: A Prospective Randomized Crossover Trial
  3. Magnetic Resonance Imaging of the Upper Airway: Effects of Propofol Anesthesia and Nasal Continuous Positive Airway Pressure in Humans
  4. Nasal mask ventilation is better than face mask ventilation in edentulous patients
  5. Nasal Ventilation Is More Effective than Combined Oral–Nasal Ventilation during Induction of General Anesthesia in Adult Subjects
  6. The effectiveness of nasal mask vs face mask ventilation in anesthetized, apneic pediatric subjects over 2 years of age: a randomized controlled trial

Risk factors for difficult mask ventilation

Literature on the predictors and prevalence of difficult mask ventilation in prehospital and clinical settings.

  1. Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document
  2. Difficult Intubation: An Analysis of 2000 Incident Reports
  3. Difficult mask ventilation in general surgical population: observation of risk factors and predictors
  4. Prediction of Difficult Mask Ventilation
  5. Incidence and Predictors of Difficult and Impossible Mask Ventilation
  6. Incidence and Predictors of Difficult Mask Ventilation in a High-Risk Adult Population
  7. Prediction of Difficult Mask Ventilation Using a Systematic Assessment of Risk Factors vs. Existing Practice — a Cluster Randomised Trial in 94,006 Patients

U.S. prevalence of risk factors

National prevalence data for the patient factors that predict a difficult mask seal.

  1. CDC / NCHS — Obesity and Severe Obesity Prevalence in Adults, United States (≈40%)
  2. CDC / NCHS — Prevalence of Tooth Loss Among Older Adults (≈13% of adults 65+)
  3. NHANES — Habitual snoring prevalence among US adults (≈35% of men, ~22% of women)
  4. Unmasking Obstructive Sleep Apnea: Estimated Prevalence and Impact in the United States (~84 million adults, ≈32%)