Noninvasive bilevel positive pressure ventilation in patients with blunt thoracic trauma.
BACKGROUND
Noninvasive bilevel positive pressure ventilation (N-BiPAP) has an established role in providing respiratory support in patients with acute respiratory failure. The significant advantage of N-BiPAP is to avoid endotracheal intubation and its complications. Currently there are no data that support N-BiPAP as first-line treatment in patients with blunt thoracic trauma.


OBJECTIVE
To evaluate the safety and efficacy of N-BiPAP in patients with acute respiratory failure due to blunt thoracic trauma.


METHODS
Prospective observational study. Twenty-two patients with blunt chest trauma (mean injury severity score 26 +/- 9) were studied. N-BiPAP was applied via a tight-fitting full or total-face mask, combined with regional anesthesia in all patients.


RESULTS
N-BiPAP resulted in significant changes in blood gasses, heart rate and breathing frequency at 1 h. Eighteen out of 22 patients avoided intubation and were discharged from the ICU (success group). Four patients met predefined criteria and required intubation (failure group) within 24 h after N-BiPAP. Three of the patients in the failure group survived while 1 developed septic shock and died. The acute response of oxygenation to N-BiPAP differed significantly between groups, being higher in the success group. Complications related to N-BiPAP were minor, consisting of nose bridge injury (1 patient) and gastric distention (1 patient).


CONCLUSIONS
N-BiPAP administration could be a safe and effective method to improve the gas exchange in patients with acute respiratory failure due to blunt thoracic trauma.
Xirouchaki
N
N
Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.
Kondoudaki
E
E
Anastasaki
M
M
Alexopoulou
C
C
Koumiotaki
S
S
Georgopoulos
D
D
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D013898:Thoracic Injuries / Q000150:complications*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*