Efficacy of nostril protector in preventing device-related pressure ulcers during endoscopic transnasal skull base surgery: a within-person quasi-randomized trial

Abstract Background This study aimed to evaluate the effectiveness of a novel nostril protection device for reducing the incidence, severity, and pain associated with medical device-related pressure ulcers (MDRPUs) in patients undergoing endoscopic transnasal skull base surgery (ETSBS). Methods This within-person, quasi-randomized, patient-blinded, single-center trial included 18 patients who underwent ETSBS. The Nostril Protector (Daiichi Medical, Tokyo, Japan) was applied to one nostril (treatment side), while the contralateral nostril served as the control. The incidence and severity of MDRPUs were assessed using the National Pressure Ulcer Advisory Panel (NPUAP) classification. Pain was evaluated using a numerical rating scale (NRS) at 0, 2, and 4 days postoperatively. Results The incidence of MDRPUs was significantly lower on the treated side than on the control side on postoperative days 2 and 4. Notably, no patients developed grade 2 or higher MDRPUs on the treatment side. While pain scores tended to be lower on the treated side, the difference was not statistically significant. Conclusions The use of the Nostril Protector effectively reduced the incidence and severity of MDRPUs during ETSBS. Although the reduction in pain was not significant, the device demonstrates clear potential as a preventive measure against MDRPUs in prolonged endoscopic procedures.