Noninvasive Bi-Level Positive Airway Pressure Ventilation in Blunt Chest Trauma
Mai Mohammed Mahran *
Emergency Medicine & Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Rehab Said El-Kalla
Anesthesia, Surgical Intensive Care, and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Ayman Abd El khalek Sallam
Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
Mohamed Ahmed El Heniedy
Vascular Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
Hala Mohey El- deen EL- Gendy
Anesthesia, Surgical Intensive Care, and Pain Management Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Chest injury was found to cause death in 20%–25% of multiple trauma patients. Thoracic trauma is, therefore, important in the overall management of multiple injury patients and may require a longer stay in the Intensive Care Unit (ICU) and use of mechanical ventilation.
Methods: This prospective randomized clinical study was in Emergency Intensive Care, Tanta University Hospitals. For, 88 adult patients with blunt chest injury. Patients were enrolled in this study aged ≥18 years old classified into two equal groups: Group I (Non-Invasive Mechanical Ventilation group) = 44 patient: Patients in this group received BIPAP. Group II (Control group=44 patient: Patients in this group have received high flow O2 by mask O2 without use of non-invasive mechanical ventilation. Data of collection were: the demographic data, Frequent arterial blood gas analysis of all patients every 6 hrs. Respiratory rate, Arterial blood pressure, Heart rate were recorded: every 6 h. All Patients receive analgesia. Evaluate outcome: a-Primary outcome. Tracheal intubation, duration of ventilation. b-Secondary outcome. Mortality, ICU length stay. And Chest Trauma Scoring System.
Results: Ten patients (22%) were intubated and mechanically ventilated in group I (BiPAP). with mean value of duration of ventilation 34.4 hrs. But at group II 16 patients (36%) were intubated and mechanically ventilated with mean value of duration of ventilation 34.12 hrs. ICU stay at group I (BiPAP) was statistically decrease of number of days when compared to group II (control). 6 days at group I and 12 days at group II. In this study no case of mortality was recorded with non-invasive ventilation, although three mortality cases were recorded with the control group.
Conclusion: This study recommends the pre-emptive use of Non-Invasive Ventilation in the treatment for blunt chest injury in patients at risk for respiratory failure. Success of Non-Invasive Ventilation depends on improvement of hypercarbia and hypoxemia in patients impending respiratory failure due to reversible cause as blunt chest trauma with the expectation of a good outcome and avoidance of intubation.
Keywords: Blunt chest trauma, noninvasive bi-level positive airway pressure ventilation, respiratory failure, hypercarbia, hypoxemia