Novel adaptor enhances care for patients on NIV

A new tube and inhaler adaptor (TIA) has been developed to improve the management of patients receiving noninvasive ventilation (NIV), and this device can be used across diverse clinical settings.

In 2018, a group of researchers designed the TIA-NIV and conducted a nonrandomized quasi-experimental study to assess its effectiveness in 196 patients in the intensive care unit (ICU) who required both NIV and enteric tube placement. The findings showed that the adaptor increased comfort and reduced air leaks relative to conventional NIV (p<0.001). [Arch Bronconeumol 2020;56:353-359]

Following its success in the trial, the TIA-NIV was used in the clinical setting to treat a diverse patient population, ranging from newborns to adults requiring NIV, with and without feeding tubes, as well as with or without inhalotherapy.

“Techniques implemented for NIV … include oxygen therapy management and lung re-expansion techniques aimed at reducing extubation failure, among other indications,” the researchers said.

For 16 months, the researchers assessed the patients’ comfort perception and the average percentage of air leak by comparing TIA-NIV with the conventional NIV. [BMJ Innovations 2025;11:74-79]

Of the patients, 84.9 percent reported being comfortable or very comfortable during NIV while using the adaptor. Air leak was significantly reduced with the TIA-NIV compared with conventional NIV (9.2 percent vs 32.5 percent; p<0.001). Moreover, the adaptor exhibited a potential role in facilitating NIV support following postextubation failure.

Airway exchange

“We previously described a patient who had an airway exchange catheter placed as part of a scheduled extubation sequence. This was done to ensure rapid airway access in case of reintubation,” the researchers said.

“Although using an airway exchange catheter could interfere with adequate NIV support by allowing air leaks in the oro-nasal mask, NIV support was successfully achieved,” they added.

The use of this adaptor improved the mask seal while maintaining the airway exchange catheter in place. [Respirol Case Rep 2020;8:e00558]

Apart from enhancing patient comfort and reducing air leaks, the TIA-NIV could prevent skin lesions, enable the provision of nutrition without worrying about leaks, and facilitate metered dose inhaler therapy while on NIV, according to the researchers. The adaptor also demonstrated its potential use in difficult airway management and its practical value in the ICU.

Limitations

“Although the TIA-NIV was designed to accommodate feeding tubes in oro-nasal masks, the risk of leakage can be influenced by individual patient morphology, which may affect the seal (eg, the presence of a beard), even with the device in use,” the researchers said.

“Further studies are needed to assess the extent of leakage reduction with TIA-NIV compared with conventional NIV therapy,” they added.

Another limitation of the TIA-NIV is its sole compatibility with the universal 22-mm calibtre oro-nasal mask ports, which limits its applicability.

The TIA-NIV “complies with international standards for medical devices, specifically ISO 5356-1:2015 (Conical connectors for fittings of breathing systems and driving gases) and ISO 20072:2013 (Anaesthetic and respiratory equipment—breathing tubes—Part 2: low-pressure breathing tubes,” according to the researchers.