INTRODUCTION: The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation. METHOD: The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group (n = 27) received mechanical ventilation with ETI, whereas patients in the CPAP group (n = 25) received CPAP via a face mask with patient controlled analgesia (PCA). Major complications, arterial blood gas levels, length of intensive care unit (ICU) stay and ICU survival rate were recorded. RESULTS:Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO(2) was significantly higher in the ET group in the first 2 days (p<0.05). There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received IPPV (p<0.01). CONCLUSION: Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma.
RCT Entities:
INTRODUCTION: The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation. METHOD: The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group (n = 27) received mechanical ventilation with ETI, whereas patients in the CPAP group (n = 25) received CPAP via a face mask with patient controlled analgesia (PCA). Major complications, arterial blood gas levels, length of intensive care unit (ICU) stay and ICU survival rate were recorded. RESULTS:Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO(2) was significantly higher in the ET group in the first 2 days (p<0.05). There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received IPPV (p<0.01). CONCLUSION: Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma.
Authors: M R Moon; F A Luchette; S W Gibson; J Crews; G Sudarshan; J M Hurst; K Davis; J A Johannigman; S B Frame; J E Fischer Journal: Ann Surg Date: 1999-05 Impact factor: 12.969
Authors: M Antonelli; G Conti; M Rocco; M Bufi; R A De Blasi; G Vivino; A Gasparetto; G U Meduri Journal: N Engl J Med Date: 1998-08-13 Impact factor: 91.245
Authors: Sean P Keenan; Tasnim Sinuff; Karen E A Burns; John Muscedere; Jim Kutsogiannis; Sangeeta Mehta; Deborah J Cook; Najib Ayas; Neill K J Adhikari; Lori Hand; Damon C Scales; Rose Pagnotta; Lynda Lazosky; Graeme Rocker; Sandra Dial; Kevin Laupland; Kevin Sanders; Peter Dodek Journal: CMAJ Date: 2011-02-14 Impact factor: 8.262
Authors: Annia Schreiber; Fatma Yıldırım; Giovanni Ferrari; Andrea Antonelli; Pablo Bayoumy Delis; Murat Gündüz; Marcin Karcz; Peter Papadakos; Roberto Cosentini; Yalım Dikmen; Antonio M Esquinas Journal: Turk J Anaesthesiol Reanim Date: 2018-04-01