Continuous positive airway pressure ventilation versus Bi-level positive airway pressure ventilation in patients with blunt chest trauma

IntroductionThe use of positive pressure ventilation has decreased the overall morbidity and mortality associated with blunt chest trauma, but invasive mechanical ventilation (IMV) is associated with many complications. The role of noninvasive ventilation (NIV) for the management of patients with blunt chest trauma has not been well established. The aim of this study was to compare the efficiency of CPAP versus BiPAP in avoiding IMV.Patients and methodThis study was carried out in the period between April 2011 and April 2103, on 40 patients admitted to ICU with blunt chest trauma with acute respiratory distress that had deteriorated despite aggressive medical management. Patients were randomly assigned to receive either continuous positive airway pressure ventilation (CPAP) (group 1) n = 15, Bi-level positive airway pressure ventilation (BiPAP) (group 2) n = 15 or IMV (group 3) n = 10.ResultsImprovement in gas exchange and relieve of respiratory distress was noticed in the three studied groups after the start of assisted ventilation. Four patients in group 1 (26.7%) and three patients in group 2 (20%) required endotracheal intubation. There was no significant difference in the length of stay in ICU between the three groups (10 ± 5 days in group 1, 11 ± 4 in group 2 and 10 ± 6 in group 3. Pneumonia developed in one patient in group 1 (6.6%) and in 2 patients in group 2 (13.3%) and in 3 patients in group 3 (30.3%). Pneumothorax developed in one patient in group 1 (6.6%) and in no patients in group 2 (0%) and in one patient in group 3 (10%). As regards mortality no mortalities were observed in groups 1 and 2 but one patient in group 3 (10%) died.ConclusionBoth CPAP and BiPAP are safe and efficient techniques in managing respiratory failure and reducing the incidence of intubation in patients with blunt chest trauma.