Noninvasive positive pressure ventilation in patients with blunt chest trauma and acute respiratory failure

Background and objective

Noninvasive positive pressure ventilation (NPPV) has been reported to be beneficial in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD), and to facilitate weaning. In this trial we assessed the possible benefit of early NPPV in patients with blunt chest trauma and acute respiratory failure.

Methods and design

Eighteen patients admitted to ICU were enrolled in this prospective randomized study. Inclusion criteria were isolated blunt chest trauma with respiratory failure and ICU stay more than 7 days. Exclusion criteria were history of COPD and conditions when NPPV was contraindicated. The patients were randomized into two groups. Group 1 (n = 9) received standard therapy (oxygen, regional analgesia, fluid and nutritional support, pulmonary physiotherapy/rehabilitation) including tracheal intubation and mechanical ventilation when indicated. Group 2 (n = 9) received standard therapy along with NPPV. In Group 2 we used NPPV with face mask and Pressure Support (7–21 cmH₂O)/CPAP (3–10 cmH₂O) ventilation. The need for tracheal intubation was assessed and the number of intubated patient in both groups was recorded on the 12, 24, 48, 96th hour and 7th day. The effect of the therapy was assessed on the 1, 6 and 12th hour using PO₂/FiO₂ index, frequency/tidal volume index (f/Vt), dispnea score, hemodynamics and the tolerance to pulmonary physiotherapy/rehabilitation.

Results and discussion

The main results suggest the possible beneficial effect of NPPV in decreasing the need for tracheal intubation and mechanical ventilation (Group 1 – intubated 7 [78%], Group 2 – intubated 3 [34%]). We found a significant statistical difference with improvement in all parameters (PO₂/FiO₂ index, frequency/tidal volume index (f/Vt), dispnea score, hemodynamics and the tolerance to pulmonary physiotherapy/rehabilitation) in the NPPV group. The results show that NPPV should be considered as systemic approach in management of all patients with blunt chest trauma and acute respiratory failure.