Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review

Abstract

IntroductionThis systematic review looks at the use of noninvasive ventilation (NIV), inclusive of noninvasive positive pressure ventilation (NPPV) and continuous positive pressure ventilation (CPAP), in patients with chest trauma to determine its safety and clinical efficacy in patients with blunt chest trauma who are at high risk of acute lung injury (ALI) and respiratory failure.MethodsWe searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Pairs of reviewers abstracted relevant clinical data and assessed the methodological quality of randomized controlled trials (RCTs) using the Cochrane domain and observational studies using the Newcastle-Ottawa Scale.ResultsNine studies were included (three RCTs, two retrospective cohort studies and four observational studies without a comparison group). There was significant heterogeneity among the included studies regarding the severity of injuries, degree of hypoxemia and timing of enrollment. One RCT of moderate quality assessed the use of NPPV early in the disease process before the development of respiratory distress. All others evaluated the use of NPPV and CPAP in patients with blunt chest trauma after the development of respiratory distress. Overall, up to 18% of patients enrolled in the NIV group needed intubation. The duration of NIV use was highly variable, but NIV use itself was not associated with significant morbidity or mortality. Four low-quality observational studies compared NIV to invasive mechanical ventilation in patients with respiratory distress and showed decreased ICU stay (5.3 to 16 days vs 9.5 to 15 days), complications (0% to 18% vs 38% to 49%) and mortality (0% to 9% vs 6% to 50%) in the NIV group.ConclusionsEarly use of NIV in appropriately identified patients with chest trauma and without respiratory distress may prevent intubation and decrease complications and ICU length of stay. Use of NIV to prevent intubation in patients with chest trauma who have ALI associated with respiratory distress remains controversial because of the lack of good-quality data.

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

“…Four patients in the CPAP-ventilation group (26.7%) and three patients in the BiPAP group (20%) required endotracheal intubation, so the success rate to avoid intubation was 73.3% in the CPAP group and 80% in the BiPAP group (Table 4), this agrees with the finding of Duggal et al 2013 [20]. The reasons for intubation ( Table 5) were failure of noninvasive ventilation to maintain the PaO 2 above 60 mmHg (four patients), its inability to correct dyspnea (two patients) and hemo-dynamic instability (one patient).…”

“…Nosocomial pneumonia and pneumo-thorax were the most commonly reported adverse events associated with NIV use in previous studies, and the rate ranged from 8% to 13.8% [20,21]. The rate of pneumothorax reported in two studies ranged from 5.5% to 24% [21,22].…”

High-Flow Nasal Cannula in a Mixed Adult ICU

“…17 Another review reported that blunt chest trauma subjects benefited from early initiation of NIV, leading to decreased ICU stay, complications, and mortality. 16 Nevertheless, neither of these studies included HFNC, even though some literature has proposed that HFNC is equivalent or superior to standard NIV. 4,12 If HFNC performs similarly to, or even better than, standard NIV devices, HFNC therapy may have analogous benefits to medical and trauma patients who were found in the aforementioned studies using NIV.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] HFNC has been used successfully with medical ICU patients, as well as in postoperative cardiac and vascular populations. 3,6,[10][11][12][13][14][15] One study in the trauma literature supported use of early noninvasive ventilation (NIV) in blunt trauma, 16 but much work is yet to be done regarding use of HFNC in trauma populations.…”

Physiotherapy in severe polytrauma patients: a therapeutic care model

“…The use of NIV is contraindicated in cases of non-drained pneumothorax. [23][24][25][26][27] -It is strongly recommended that the physiotherapist review the imaging exams (CT scans and/or x-rays) before attending them and discuss them with the medical staff.…”