Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review (original) (raw)
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Mechanical ventilation in trauma-the first 24 hours: A retrospective analysis
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Warfare injuries are a special subset of trauma, involving complex injury mechanisms and extensive tissue damage. Theses mechanisms may lead to significant deterioration in lung function even in the absence of any signs of external thoracic injury due to primary or secondary insult on the lungs. The mainstay in the management of these battlefield lung injuries is by initiating mechanical ventilation which either replaces or assists the functions of the respiratory system. Materials and Methods: A retrospective analysis was done from 1st January 2016 to 31st June 2016 of the data taken from the trauma register of our hospital. Data was analysed and the need for mechanical ventilation was correlated with factors like injury severity score (ISS), injury profile and pulmonary and extrapulmonary using confidence interval and Odds ratio. Paired differences were tested using Wilcoxon signed rank test. Results: Of the 528 warfare casualties received a total of 469 patients were enrolled and 94(20.04%) required mechanical ventilation in the immediate post-operative period and another 06 patients needed ventilation in the first 24 hours due to development of fat embolism syndrome. All patients had an ISS of greater than 27(48.9±12.6) as compared to non-ventilated patients (odds 1.1, 95% CI, 0.85-1.45, P=0.42). Conclusion: Acute lung injury is a major cause of increased morbidity in patients with warfare injuries. An aggressive and proactive approach of initiating mechanical ventilation can bring down complications and ICU stays. Injury severity scoring can be used for predicting ALI in warfare casualties. Lung protective ventilatory strategies can enhance patient recovery. Keywords: Mechanical ventilation, Trauma, Lung injury.
Critical Care, 2013
Introduction: This systematic review looks at the use of noninvasive ventilation (NIV), inclusive of noninvasive positive pressure ventilation (NPPV) and continuous positive pressure ventilation (CPAP), in patients with chest trauma to determine its safety and clinical efficacy in patients with blunt chest trauma who are at high risk of acute lung injury (ALI) and respiratory failure. Methods: We searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Pairs of reviewers abstracted relevant clinical data and assessed the methodological quality of randomized controlled trials (RCTs) using the Cochrane domain and observational studies using the Newcastle-Ottawa Scale.
Noninvasive ventilation in trauma
World Journal of Critical Care Medicine, 2015
The use of noninvasive ventilation is widely recognized as a suitable way to avoid intubation and its associated side effects. Noninvasive ventilation allows increased flexibility in the application and discontinuation of ventilator assistance and preserves airway defense mechanisms. The application of noninvasive ventilation may reduce the need to intubate patients with traumarelated hypoxemia, thereby potentially decreasing intensive care unit length of stay and preventing respiratory complications. In this review article, we summarize the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma.
Mechanical Ventilation in the Trauma Patient
Mechanical Ventilation [Working Title], 2021
In this chapter, we discuss the unique ventilatory strategies of the trauma patient. Injuries can be direct to the lung resulting from the trauma or indirect because of other injury to the body. We will discuss the airway and ventilation management and concerns in a patient with chest trauma, abdominal trauma, head trauma, orthopedic, and burn injury. The chapter will explain lung-protective strategies as well as innovative ventilation management techniques including extracorporeal membrane oxygenation.
Noninvasive Ventilation Reduces Intubation in Chest Trauma-Related Hypoxemia
Chest, 2010
I ntubation rates reported in patients with chest trauma range from 23% to 75%, mainly depending on trauma severity, the presence of underlying pulmonary disease, associated injuries, and the intensity of ICU monitoring and management. 1,2 However, in a multicenter survey, posttraumatic hypoxemic respiratory failure responded favorably to noninvasive mechanical ventilation (NIMV), with a moderate rate of NIMV failure (18%). 3 The critical care management of these patients has focused on surgical stabilization, fl uid management, pulmonary toilet, and control of chest wall pain; ven-tilatory management has received little attention, 4-8 and this is refl ected in the low-grade recommendation for NIMV in trauma patients in the British Thoracic Society guidelines. 9 Previous studies focused on NIMV in hypoxemic patients include a mixed population with a low percentage of trauma patients or are limited to comparisons with invasive ventilation. 10 Moreover, to our knowledge, no studies have explored the potential usefulness of NIMV in preventing intubation when hypoxemia develops after chest trauma. One randomized clinical trial 11 examined ventilatory management but excluded Background: Guidelines for noninvasive mechanical ventilation (NIMV) recommend continuous positive airway pressure in patients with thoracic trauma who remain hypoxic despite regional anesthesia. This recommendation is rated only by level C evidence because randomized controlled trials in this specifi c population are lacking. Our aim was to determine whether NIMV reduces intubation in severe trauma-related hypoxemia. Methods: This was a single-center randomized clinical trial in a nine-bed ICU of a level I trauma hospital. Inclusion criteria were patients with Pa O 2 /F IO 2 , 200 for. 8 h while receiving oxygen by high-fl ow mask within the fi rst 48 h after thoracic trauma. Patients were randomized to remain on high-fl ow oxygen mask or to receive NIMV. The interface was selected based on the associated injuries. Thoracic anesthesia was universally supplied unless contraindicated. The primary end point was intubation; secondary end points included length of hospital stay and survival. Statistical analysis was based on multivariate analysis. Results: After 25 patients were enrolled in each group, the trial was prematurely stopped for effi cacy because the intubation rate was much higher in controls than in NIMV patients (10 [40%] vs 3 [12%], P 5 .02). Multivariate analysis adjusted for age, gender, chronic heart failure, and Acute Physiology and Chronic Health Evaluation II at admission revealed NIMV as the only variable independently related to intubation (odds ratio, 0.12; 95% CI, 0.02-0.61; P 5 .01). Length of hospital stay was shorter in NIMV patients (14 vs 21 days P 5 .001), but no differences were observed in survival or other secondary end points. Conclusion: NIMV reduced intubation compared with oxygen therapy in severe thoracic traumarelated hypoxemia. Trial registration: clinicaltrials.gov; identifi er: NCT 00557752.
Mechanical ventilation during acute lung injury: Current recommendations and new concepts
2011
Themostsever e forms of acute respiratory failure, such as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), are relatively common in the ICU setting [1]. The estimated crude incidences for ALI and ARDS in the United States are 78.9 and 58.7 cases per 100,000 persons/year respectively, higher than previous reported [1,2]. Projections suggest that as the population ages there will be a further increase in the incidence in the United States from 190,000 patients/year to 300,000/year in 2025-2030 [2]. Furthermore, the incidence will likely increase dramatically during the outbreaks of acute viral infections such as SARS and H1N1. The first description of ARDS appeared in 1967, in a paper by Ashbaugh et al. which described 12 patients with acute respiratory distress, cyanosis refractory to oxygen therapy, decrease lung compliance, and diffuse infiltrates on the chest radiography [3]. Several clinical disorders have
Non invasive respiratory support in a multi-trauma setting : A case report
2011
Introduction: Non invasive respiratory support has been used in a wide variety of settings. This case report illustrates the benefit of such support in a complex multi-trauma patient. Case presentation: A 42 year-old male restrained driver was brought to the trauma bay with multiple injuries. These included: aortic transection, frontal lobe hemorrhages, bilateral pneumothoraces, multiple rib fractures, diaphragmatic rupture, C7 fracture, and pubic rami fractures. After surgical repair, the patient was transferred to the Kessler Burn Trauma ICU sedated and ventilated. Serial bronchoscopies were performed to improve aeration of his left lung over the next week. The patient was extubated on POD # 9 but required reintubation the following day due to lung collapse. A regimen of non invasive positive pressure ventilation was initiated to avoid reintubation for repeated bronchoscopies. The therapy was successful and the patient progressed to room air after one week. Conclusion: Studies hav...
Journal of Trauma and Acute Care Surgery, 2012
BACKGROUND: Airway pressure release ventilation (APRV) is used both as a rescue therapy for patients with acute lung injury and as a primary mode of ventilation. Unlike assist-control volume (ACV) ventilation that uses spontaneous breathing trials, APRV weaning consists of gradual decreases in supporting pressure. We hypothesized that the APRV weaning process increases total ventilator days compared with those of spontaneous breathing trialsYbased weaning. METHODS: A retrospective review of a Level I trauma center's database identified trauma admissions from January 1, 2007, to December 31, 2010, which required mechanical ventilation for more than 24 hours and survived. Demographics, injuries, in-hospital complications, ventilation mode(s), and total ventilator days were abstracted. RESULTS: A total of 362 patients fulfilled study entry criteria; 53 patients with more than one ventilator mode change were excluded. Seventy-five patients were successfully liberated from mechanical ventilation on APRV and 234 on ACV. The APRVand ACV groups, respectively, were similar in age (46.1 vs. 44.6 years) and sex (72% vs. 73% male) but differed in Injury Severity Score (20.8 vs. 17.5; p = 0.03). Patients on APRV had higher rates of abdominal compartment syndrome (6.7% vs. 0.8%, p = 0.003) and were more likely to have a higher chest Abbreviated Injury Scale (AIS) score Q3 (57.3% vs. 30.8%, p G 0.001). Ventilator days were significantly greater in the APRV group (19.6 vs. 10.7 days, p G 0.001). Multiple regression was performed to adjust for the clinical differences between the two groups, identifying APRV as an independent predictor for increased number of ventilator days (B = 6.2 T 1.5, p G 0.001) in addition to male sex, abdomen AIS score of 3 or higher, spine AIS score of 3 or higher, acute renal failure, and sepsis. CONCLUSION: APRV is frequently used for patients who are more severely injured or who develop in-hospital complications such as pneumonia. However, after controlling for potential confounding factors in a multiple regression model, the APRV mode itself seems to increase ventilator days.
The journal of trauma and acute care surgery, 2013
Adult respiratory distress syndrome is often refractory to treatment and develops after entering the health care system. This suggests an opportunity to prevent this syndrome before it develops. The objective of this study was to demonstrate that early application of airway pressure release ventilation in high-risk trauma patients reduces hospital mortality as compared with similarly injured patients on conventional ventilation. Systematic review of observational data in patients who received conventional ventilation in other trauma centers were compared with patients treated with early airway pressure release ventilation in our trauma center. Relevant studies were identified in a PubMed and MEDLINE search from 1995 to 2012 and included prospective and retrospective observational and cohort studies enrolling 100 or more adult trauma patients with reported adult respiratory distress syndrome incidence and mortality data. Early airway pressure release ventilation as compared with the ...