Christopher A Butts1, John J Brady1, Sara Wilhelm2, Laura Castor2, Alicia Sherwood2, Abby McCall2, John Patch2, Pamela Jones2, Vicente Cortes2, Adrian W Ong3. 1. Department of Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, United States. 2. Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States. 3. Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States. Electronic address: Adrian.Ong@readinghealth.org.
Abstract
BACKGROUND: We evaluated if incentive spirometry volume (ISV) and peak expiratory flow rate (PEFR) could predict acute respiratory failure (ARF) in patients with rib fractures. METHODS: Normotensive, co-operative patients were enrolled prospectively. ISV and PEFR were measured on admission, at 24 h and at 48 h by taking the best of three readings each time. The primary outcome, ARF, was defined as requiring invasive or noninvasive positive pressure ventilation. RESULTS: 99 patients were enrolled (median age, 77 years). ARF occurred in 9%. Of the lung function tests, only a low median ISV at admission was associated with ARF (500 ml vs 1250 ml, p = 0.04). Three of 69 patients with ISV of ≥1000 ml versus six of 30 with ISV <1000 ml developed ARF (p = 0.01). Other significant factors were: number of rib fractures, tube thoracostomy, any lower-third rib fracture, flail segment. CONCLUSION: PEFR did not predict ARF. Admission ISV may have value in predicting ARF.
BACKGROUND: We evaluated if incentive spirometry volume (ISV) and peak expiratory flow rate (PEFR) could predict acute respiratory failure (ARF) in patients with rib fractures. METHODS: Normotensive, co-operative patients were enrolled prospectively. ISV and PEFR were measured on admission, at 24 h and at 48 h by taking the best of three readings each time. The primary outcome, ARF, was defined as requiring invasive or noninvasive positive pressure ventilation. RESULTS: 99 patients were enrolled (median age, 77 years). ARF occurred in 9%. Of the lung function tests, only a low median ISV at admission was associated with ARF (500 ml vs 1250 ml, p = 0.04). Three of 69 patients with ISV of ≥1000 ml versus six of 30 with ISV <1000 ml developed ARF (p = 0.01). Other significant factors were: number of rib fractures, tube thoracostomy, any lower-third rib fracture, flail segment. CONCLUSION: PEFR did not predict ARF. Admission ISV may have value in predicting ARF.