title: The role of non-invasive ventilation in blunt chest trauma: systematic review and meta-analysis.
abstract: OBJECTIVE
  Respiratory support is the mainstay for the management of patients with pulmonary contusion following blunt chest trauma. In patients not requiring immediate intubation and ventilation, the optimal respiratory management strategy is not clear. This systematic review and meta-analysis aimed to determine the efficacy of non-invasive ventilation (NIV), as compared to traditional respiratory support strategies (i.e., high-flow facemask oxygen or pre-emptive intubation and ventilation), in adult patients with blunt chest trauma.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing NIV to traditional forms of respiratory support (i.e., facemask oxygen or intubation and ventilation) in an adult trauma population. For each eligible trial, we extracted the outcomes of all-cause mortality, length of intensive care unit (ICU) stay, length of hospital stay, and pneumonia.
  
  
  RESULTS
  We identified 643 citations, selected 17 for full-text evaluation, and identified three eligible RCTs. Patients receiving NIV had a non-significant reduction in the risk of death (OR 0.55; 95 % CI 0.18-1.70; I (2) = 0 %), but significant reductions in length of ICU stay (mean difference -2.45 days; 95 % CI -4.27 to -0.63; I (2) = 66 %), length of hospital stay (mean difference -4.60 days; 95 % CI -8.81 to -0.39; I (2) = 85 %), and risk of pneumonia (OR 0.20; 95 % CI 0.09-0.47; I (2) = 0 %).
  
  
  CONCLUSIONS
  This meta-analysis suggests that NIV is superior to both high-flow facemask oxygen or pre-emptive intubation and ventilation in patients with blunt chest trauma who have no contraindication to NIV.
authors.affiliation: Perioperative Research Group, Department of Anaesthetics and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. steveroberts@mweb.co.za.
authors.forename: S
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Perioperative Research Group, Department of Anaesthetics and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Perioperative Research Group, Department of Anaesthetics and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Biccard
authors.affiliation: Perioperative Research Group, Department of Anaesthetics and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.|Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Rodseth
keywords: Artificial ventilation; Blunt chest trauma; Non-invasive ventilation; Positive pressure ventilation; Thorax injury
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