title: Treatment of multiple rib fractures. Randomized controlled trial comparing ventilatory with nonventilatory management.
abstract: We studied the treatment of multiple rib fractures in NIC, comparing ventilatory with nonventilatory methods in 69 patients who were randomly allocated to one of the following two treatments: (1) a CPAP mask combined with regional analgesia (n = 36); or (2) endotracheal intubation and mechanical ventilation with PEEP (n = 33). Clinical outcome was as follows: mean duration of treatment, 4.5 +/- 2.3 days for the group with CPAP and 7.3 +/- 3.7 days for the intubated group (p = 0.0003); mean number of days spent in intensive care, 5.3 +/- 2.9 days and 9.5 +/- 4.4 days, respectively (p = less than 0.0001); mean period of hospitalization, 8.4 +/- 7.1 days and 14.6 +/- 8.6 days, respectively (p = 0.0019); and patients developing complications: 28 percent (10/36) and 73 percent (24/33), respectively. Infections caused the difference in complications, primarily pneumonias, which occurred in 14 percent (5/36) of the group with CPAP but in 48 percent (16/33) of the intubated group. We conclude that treatment with a CPAP mask combined with regional analgesia can shorten and simplify treatment in these patients, mainly through a decreased infection rate, when compared with intubation and mechanical ventilation, and we recommend this treatment in patients similar to our sample.
authors.affiliation: Department of Internal Medicine, Tygerberg Hospital, Cape Town, South Africa.
authors.forename: C T
authors.initials: CT
authors.lastname: Bolliger
authors.forename: S F
authors.initials: SF
authors.lastname: Van Eeden
mesh_terms: D000698:Analgesia; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012253:Rib Fractures / Q000503:physiopathology / Q000628:therapy*