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Borràs-Novell, et al.
Finally, the physical characteristics of the 3D printed tailor-made masks in optimizing patient’s ventilation, and
prototype allow the incorporation of an adhesive silicone especially their ability to reduce skin ulcerations.
strip in the contour that rests on manikin; this strip does not
damage the skin when it is removed. This extra adherence 4. Conclusions
may reduce damage caused by friction mechanisms, instead Our research team has tested and validated the technical
of pressure mechanisms. Willox et al. added granuflexv to viability of designing and printing silicone tailor-made
their printed prototype to cushion the edges as the mask 3D facial masks for NIV to a very preterm manikin
seems more rigid . The adhesive silicone strip could also (Anne Premature from Laerdel ). The customization of
[8]
®
be used in commercially available masks. these non-invasive masks allows perfect fit of the specific
The use of a resuscitation manikin in this study anatomic features of any given patient’s face. In near
enabled us to connect a ventilation system to the manikin future, these tailor-made masks could reduce air leaks
to check the correct thoracic excursion with the use of and allow for a homogeneous distribution of pressure on
a tailor-made mask. However, due to such use of the the skin, thereby optimizing NIV and reducing the risk
phantom, other ventilatory parameters could not be tested. for skin ulcers, respectively.
3D printing can also become a potentially useful tool
for both patients and health personnel in the background Acknowledgments
of the COVID-19 pandemic. Individualized printed
masks represent an improvement in NIV therapies for The authors would like to thank Avinent Implant System
patients affected by respiratory failure. On the other hand, S.L.U. and Elkem Silicones France SAS, especially
customized masks could also play a role in the protection Lauriane Depernon (Technical Service Manager Skin
of healthcare personnel; some studies have demonstrated Adhesives - Compentence Center – ATRiON), for their
the application of 3D printing in the development of technological support and knowledge in the development
personal protective equipment and respiratory protective of this project.
devices [7,17-19] . The authors would like also to thank to the Skin
At the end of the study, we estimated that the price of Adverse Events’ Working Group of the Neonatology
making an individualized mask was 80 euros at the time. Department of Hospital Clínic for their collaboration,
To prevent NIV-related skin ulcerations, our hospital’s their expertise has been fundamental.
protocol recommends the alternative use of two generic
nasal masks of different sizes in every infant (these masks Funding
need to be renewed every 5 days). The total NIV days in Our project was granted by research aid Adolfo Valls-
our department are around 600 days/year, corresponding Respisurf of the Spanish Society of Neonatology (edition
to the use of approximately 250 standardized masks. This 2018).
price is, in general terms, higher than that of standardized
masks (in our case, it is 4 times higher), but we believe Conflict of interest
that the cost can be substantially reduced by automating
the design phase and by having the printer available in Authors Cristina Borràs-Novell, Mario García Causapié
the hospital. Potential clinical benefits from tailor-made and Oscar García-Algar do not have conflicts of interest.
masks can lead to a favorable cost/benefit ratio. Authors Maria Murcia and Damien Djian work in Elkem
The next step of our research team is to test the Company as Sales Manager HC&IAM Iberia and Sales
viability of the process in very preterm infants admitted Expert 3D printing Europa and R&I – Compentence
in our department. This will include the previously Center – ATRiON respectively. The mentioned companies
mentioned steps (3D facial scan, image processing, and had altruist collaboration in the current project, within the
3D printing process) by following the same methodology. framework of Research & Development.
To make sure very preterm infants could eventually benefit Author contributions
from these tailor-made masks as soon as possible, the
team is dedicated to shortening the time that it currently C.B.N. literature review, image capture, prototype design
takes to produce each mask by automating the design corrections, prototype tests, data management, data
phase. This new proposed project will be presented to the interpretation, draft manuscript, consolidation of coauthor
ethics committee of our hospital. Once ethical approval comments, and paper finalization. M.G.C. image capture,
is granted by the research ethics committee, we will prototype design, prototype tests, data interpretation, and
conduct a clinical study to test the resulting tailor-made, manuscript review. M.M prototype design and manuscript
3D-printed NIV masks and compare their effectiveness review. D.D. prototype design, prototype printing, and
and safety versus the standardized masks. The key manuscript review. O.G.A. conceptualization, work
endpoints of the project are related to the ability of the coordination, and manuscript review.

International Journal of Bioprinting (2022)–Volume 8, Issue 2 29