Chest
Original ResearchCritical Care MedicineNoninvasive Ventilation Reduces Intubation in Chest Trauma-Related Hypoxemia: A Randomized Clinical Trial
Section snippets
Patients
This prospective randomized controlled study was conducted in a 700-bed level I trauma center that works as regional referral center for traumatic brain injury. From September 2005 to June 2008, we screened all patients admitted for severe thoracic trauma to our nine-bed closed trauma ICU without out-of-hospital intubation. The study was approved by the Institutional Review Board. Informed consent was obtained from patients or relatives in all cases.
Inclusion criteria were: age older than 18
Results
At the second interim analysis, after enrollment of 50 patients, a significantly reduced intubation rate in the NIMV group led the safety monitoring board to stop the study. The Consolidated Standards of Reporting Trials study flow is summarized in Figure 1. During the 3-year study period, 79 patients were screened, but only 50 were finally included in the study, 25 randomized to each treatment group. The baseline characteristics of patients in each group are summarized in Table 1. In the
Discussion
The major finding of this study is that early and continuous NIMV prevents intubation and reduces LOS in patients who develop severe hypoxia early in the course of thoracic trauma. It seems that the time course of oxygenation does not predict NIMV failure, as Pao2/Fio2 also improved in the first 24 h in the group of patients who were eventually intubated (see Fig 3). However, the difference in the Pao2/Fio2 ratio in NIMV vs control patients when comparing patients who were intubated with those
Acknowledgments
Author contributions: Dr Hernandez: contributed to the conception, coordination, design, and interpretation of the study and drafting, critical revision, reading, and approval of the manuscript.
Dr Fernandez: contributed to the conception, design, and interpretation of the study and drafting, critical revision, reading, and approval of the manuscript.
Dr Lopez-Reina: contributed to coordination, design, and interpretation of the study and critical revision, reading, and approval of the manuscript.
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Physiotherapy management of rib fractures
2023, Journal of PhysiotherapyThoracic trauma: Respiratory support
2023, Praticien en Anesthesie ReanimationHigh flow nasal cannula outside the ICU provides optimal care and maximizes hospital resources for patients with multiple rib fractures
2022, InjuryCitation Excerpt :Other studies have investigated HFNC and other forms of noninvasive respiratory support in patients with rib fractures [16,25-28,38]. In Spain, Hernandez et al. [38] showed reductions in the intubation of patients with severe thoracic trauma with the use of noninvasive mechanical ventilation. Just as in our study, falls and motor vehicle crashes were the most common trauma mechanisms in the Hernandez et al. study [38].
Funding/Support: This study was supported in part by Consejería de Sanidad de Castilla-La Mancha [Grant 06001-00 ICS Talavera] and Fundación de Investigación Médica Mutua Madrileña Automovilística [Grant 06/06/2004 n°65].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).