Noninvasive Bilevel Positive Pressure Ventilation in Patients with Blunt Thoracic Trauma

Abstract

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.

Non-invasive ventilation and continuous positive pressure ventilation in emergency departments: where are we now?

“…In a prospective observational study, Xirouchaki et al 25 observed benefits when using NIV/CPAP in patients with blunt thoracic trauma. CPAP is currently recommended in patients with chest wall trauma if they remain hypoxic despite high flow oxygen and adequate analgesia 6.…”

Continuous positive airway pressure ventilation versus Bi-level positive airway pressure ventilation in patients with blunt chest trauma

“…Although the safety of NIV has been assessed in a number of observational studies in patients with blunt thoracic injuries [8,13], the evidence regarding the use of NIV in this setting is inconsistent [12]. The aim of this study was to compare noninvasive ventilation (CPAP and BiPAP) with invasive mechanical ventilation in management of patients with blunt chest trauma and compare the efficiency of CPAP versus BiPAP in avoiding intubation and IMV.…”

“…Intubation rates range from 23% to 75% and depend on the severity of the trauma, the degree of the underlying lung disease, and the intensity of initial management and monitoring [8,11]. The use of positive pressure ventilation has decreased the overall morbidity and mortality associated with blunt chest trauma, but endotracheal intubation and mechanical ventilation are associated with a high risk of nosocomial pneumonia and prolonged mechanical ventilation [12].The role of noninvasive ventilation (NIV) for the management of patients with blunt chest trauma has not been well established [13]. The aim of this study was to compare NIV (CPAP and BiPAP) with invasive mechanical ventilation (IMV) in management of patients with blunt chest trauma and to compare efficiency of CPAP versus BiPAP in avoiding intubation and IMV.…”

Noninvasive Positive Pressure Ventilation: Resource Document for the National Association of EMS Physicians Position Statement

“…Invasive airway management of major trauma is difficult, and NIPPV may provide transient ventilatory support in these patients. [51][52][53][54][55] However, potential NIPPV pitfalls in the setting of trauma include the risk of pneumocephalus, subcutaneous emphysema or bacterial meningitis in patients with midface fractures, pneumothorax in thoracic trauma, and increased intrathoracic pressure causing hypotension.…”