What strategy should be used when a patient complains of nasal congestion during NIV with a nasal mask?

When a patient experiences nasal congestion while using noninvasive ventilation (NIV) with a nasal mask, adding a heated humidifier is an effective strategy. Humidification helps to provide moisture to the air being delivered, which can alleviate dryness and irritation in the nasal passages. This moisture is particularly important in a noninvasive ventilation setting where the continuous airflow can lead to drying out of mucosal surfaces, contributing to feelings of congestion or discomfort.

Using a heated humidifier not only enhances patient comfort but also supports better airway patency by keeping the mucosal surfaces hydrated. Dry air can exacerbate nasal congestion, leading to a cycle of discomfort that may make ventilation less effective. As a result, employing a heated humidifier addresses the root cause of the patient's complaint and can lead to improved tolerance of the NIV.

The other strategies might not effectively resolve the issue of nasal congestion. Switching to a full face mask could change the distribution of airflow but does not specifically address the underlying dryness leading to congestion. Increasing the pressure settings may actually worsen the sensation of nasal congestion and discomfort. Reducing the ventilatory rate could lead to inadequate ventilation and might not alleviate congestion. Therefore, adding a heated humidifier is the most appropriate response to help alleviate the patient's symptoms.