A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest.
BACKGROUND
The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation.


METHODS
The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group (n = 27) received mechanical ventilation with ETI, whereas patients in the CPAP group (n = 25) received CPAP via a face mask with patient controlled analgesia (PCA). Major complications, arterial blood gas levels, length of intensive care unit (ICU) stay and ICU survival rate were recorded.


RESULTS
Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO(2) was significantly higher in the ET group in the first 2 days (p<0.05). There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received IPPV (p<0.01).


CONCLUSIONS
Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma.
Gunduz
M
M
Cukurova University Faculty of Medicine, Department of Anaesthesiology Balcali, Adana, Turkey. hmurat@cu.edu.tr
Unlugenc
H
H
Ozalevli
M
M
Inanoglu
K
K
Akman
H
H
D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000209:etiology; D005260:Female; D005409:Flail Chest / Q000150:complications / Q000628:therapy*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
D002245:Carbon Dioxide; D010100:Oxygen