What is the recommended action for a patient reporting complete nasal obstruction before PAP titration?

When a patient reports complete nasal obstruction before positive airway pressure (PAP) titration, the recommended action is to utilize an oro-nasal interface. This type of mask covers both the nose and the mouth, which allows for effective ventilation even when nasal airflow is compromised.

In situations where nasal obstruction is present, using a nasal-only interface would not provide adequate airflow, as it could exacerbate feelings of suffocation and discomfort for the patient. An oral appliance, while it can assist with airway management, is generally not used in the context of PAP therapy titration since it does not provide the necessary pressure support nor does it address potential obstructive issues as effectively as a mask. A full-face mask could be a viable option; however, the oro-nasal interface is typically preferred when there is a complete nasal obstruction. This choice allows for better monitoring of the patient's response to therapy while ensuring that there are no interruptions in the delivery of air pressure.