Table 1 Study characteristics.a
Study (design) | Patients (n)/country | Study intervention | Control intervention | Severity of hypoxemia | Quantification of severity of chest injury | Strategy for pain control |
|---|---|---|---|---|---|---|
I. Early interventions: CPAP/NPPV compared to supplemental oxygen | ||||||
Hernandez et al. (2010) (RCT) | 50/Spain | NPPV | High-flow oxygen | PaO2/FiO2 ≤200 for >8 h | Thoracic AIS, ISS, lung contusions/quadrant, thoracolumbar vertebral trauma, flail chest | Epidural analgesia (bupivacaine and fentanyl) Remifentanil infusion |
II. Late interventions: CPAP/NPPV after development of respiratory distress | ||||||
Xirouchaki et al. (2004) (case series) | 22/Greece | NPPV | None | PaO2/FiO2 ≤140 | AIS, ISS | Epidural analgesia IV analgesia (not specified) |
Tanaka et al. (2001) (case series) | 59/Japan | CPAP | None | Not Reported | AIS, ISS, flail chest | Epidural analgesia (not specified) |
Walz et al., 1998 (case series) | 30/Germany | CPAP | None | PaO2 ≤70 | Isolated or accompanying chest trauma on one or both sides | Epidural analgesia Intercostal nerve blocks IV analgesia |
Hurst et al. (1985) (case series) | 33/USA | CPAP | None | PaO2/FiO2 <150 or PaO2 <65 | Chest trauma (lung contusions, rib fractures) No severity score used | Not specified |
III. Patient safety assessment: CPAP/NPPV compared to mechanical ventilation after development of respiratory distress | ||||||
Gunduz et al. (2005) (RCT) | 43/Turkey | CPAP | Mechanical ventilation | PaO2/FiO2 ≤300 | TTSS, five or more rib fractures in a row, three or more segmental rib fractures, flail chest | Morphine patient Controlled analgesia |
Bolliger and Van Eeden (1990) (RCT) | 69/South Africa | CPAP | Mechanical ventilation | PaO2/FiO2 ≥150 | ISS, more than three rib fractures, pulmonary contusion | Lumbar epidural analgesia (buprenorphine) Intercostal nerve blocks |
Vidhani et al. (2001) (retrospective cohort) | 75/Australia | NPPV | Mechanical ventilation | PaO2 <65 or PaO2/FiO2 ≤300 | ISS, unilateral or bilateral lung contusion, flail chest | Epidural analgesia Patient-controlled analgesia Oral analgesics |
Linton et al. (1982) (retrospective cohort) | 26/South Africa | CPAP | Mechanical ventilation | PaO2/FiO2 ≥150 | Number of rib fractures, bilateral rib fractures, flail chest | Epidural analgesia (buprenorphine and morphine) |