Skip to main content
SpringerLink
Log in

The role of non-invasive ventilation in blunt chest trauma: systematic review and meta-analysis

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Respiratory support is the mainstay for the management of patients with pulmonary contusion following blunt chest trauma. In patients not requiring immediate intubation and ventilation, the optimal respiratory management strategy is not clear. This systematic review and meta-analysis aimed to determine the efficacy of non-invasive ventilation (NIV), as compared to traditional respiratory support strategies (i.e., high-flow facemask oxygen or pre-emptive intubation and ventilation), in adult patients with blunt chest trauma.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing NIV to traditional forms of respiratory support (i.e., facemask oxygen or intubation and ventilation) in an adult trauma population. For each eligible trial, we extracted the outcomes of all-cause mortality, length of intensive care unit (ICU) stay, length of hospital stay, and pneumonia.

Results

We identified 643 citations, selected 17 for full-text evaluation, and identified three eligible RCTs. Patients receiving NIV had a non-significant reduction in the risk of death (OR 0.55; 95 % CI 0.18–1.70; I 2 = 0 %), but significant reductions in length of ICU stay (mean difference −2.45 days; 95 % CI −4.27 to −0.63; I 2 = 66 %), length of hospital stay (mean difference −4.60 days; 95 % CI −8.81 to −0.39; I 2 = 85 %), and risk of pneumonia (OR 0.20; 95 % CI 0.09–0.47; I 2 = 0 %).

Conclusion

This meta-analysis suggests that NIV is superior to both high-flow facemask oxygen or pre-emptive intubation and ventilation in patients with blunt chest trauma who have no contraindication to NIV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Borman JB, et al. Unilateral flail chest is seldom a lethal injury. Emerg Med J. 2006;23(12):903–5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  2. Galan G, et al. Blunt chest injuries in 1696 patients. Eur J Cardiothorac Surg. 1992;6(6):284–7.

    Article  PubMed  CAS  Google Scholar 

  3. Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982;196(4):481–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Veysi VT, et al. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop. 2009;33(5):1425–33.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin. 2004;20(1):71–81.

    Article  PubMed  Google Scholar 

  6. Bastos R, Calhoon JH, Baisden CE. Flail chest and pulmonary contusion. Semin Thorac Cardiovasc Surg. 2008;20(1):39–45.

    Article  PubMed  Google Scholar 

  7. Nirula R, Mayberry JC. Rib fracture fixation: controversies and technical challenges. Am Surg. 2010;76(8):793–802.

    PubMed  Google Scholar 

  8. Trinkle JK, et al. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975;19(4):355–63.

    Article  PubMed  CAS  Google Scholar 

  9. Klopfenstein CE, Forster A, Suter PM. Pneumocephalus. A complication of continuous positive airway pressure after trauma. Chest. 1980;78(4):656–7.

    Article  PubMed  CAS  Google Scholar 

  10. Kaunitz VH. Flail chest. J Thoracic Cardiovasc Surg. 1981;82(3):463.

    CAS  Google Scholar 

  11. Linton DM, Potgieter PD. Conservative management of blunt chest trauma. S Afr Med J Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1982;61(24):917–9.

    CAS  Google Scholar 

  12. Tranbaugh RF, Lewis FR. Respiratory insufficiency. Surg Clin North Am. 1982;62(1):121–32.

    PubMed  CAS  Google Scholar 

  13. Hurst JM, DeHaven CB, Branson RD. Use of CPAP mask as the sole mode of ventilatory support in trauma patients with mild to moderate respiratory insufficiency. J Trauma-Injury Infect Crit Care. 1985;25(11):1065–8.

    CAS  Google Scholar 

  14. Potgieter PD, Rosenthal E, Benatar SR. Immediate and long-term survival in patients admitted to a respiratory ICU. Crit Care Med. 1985;13(10):798–802.

    Article  PubMed  CAS  Google Scholar 

  15. Bolliger CT, Van Eeden SF. Treatment of multiple rib fractures. Randomized controlled trial comparing ventilatory with nonventilatory management. Chest. 1990;97(4):943–8.

    Article  PubMed  CAS  Google Scholar 

  16. Walz M, Mollenhoff G, Muhr G. CPAP-augmented spontaneous respiration in thoracic trauma. An alternative to intubation. Unfallchirurg. 1998;101(7):527–36.

    Article  PubMed  CAS  Google Scholar 

  17. Beltrame F, et al. Noninvasive positive pressure ventilation in trauma patients with acute respiratory failure. Monaldi Arch Chest Dis. 1999;54(2):109–14.

    PubMed  CAS  Google Scholar 

  18. Garfield MJ, Howard-Griffin RM. Non-invasive positive pressure ventilation for severe thoracic trauma. Br J Anaesth. 2000;85(5):788–90.

    Article  PubMed  CAS  Google Scholar 

  19. Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin. 2004;20(1):71–81.

    Article  PubMed  Google Scholar 

  20. Balci AE, et al. Unilateral post-traumatic pulmonary contusion: findings of a review. Surg Today. 2005;35(3):205–10.

    Article  PubMed  Google Scholar 

  21. Gunduz M, et al. A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest. Emerg Med J. 2005;22(5):325–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Xirouchaki N, et al. Noninvasive bilevel positive pressure ventilation in patients with blunt thoracic trauma. Respiration. 2005;72(5):517–22.

    Article  PubMed  CAS  Google Scholar 

  23. Trevisan CE, Vieira SR. Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial. Crit Care. 2008;12(2):R51.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hernandez G, et al. Noninvasive ventilation reduces intubation in chest trauma-related hypoxemia: a randomized clinical trial. Chest. 2010;137(1):74–80.

    Article  PubMed  Google Scholar 

  25. Wigfield C et al. Oxygenation after pulmonary contusion in blunt thoracic trauma. Am J Respir Crit Care Med. Conference: American Thoracic Society International Conference, ATS, 2011. 183 (1 Meeting Abstracts).

  26. Cohn SM, Dubose JJ. Pulmonary contusion: an update on recent advances in clinical management. World J Surg. 2010;34(8):1959–70.

    Article  PubMed  Google Scholar 

  27. Clemedson CJ. Blast injury. Physiol Rev. 1956;36(3):336–54.

    PubMed  CAS  Google Scholar 

  28. Miller PR, et al. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg. 2002;68(10):845–50 discussion 850–1.

    PubMed  Google Scholar 

  29. Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Dr Rodseth is supported by a CIHR Scholarship (the Canada-HOPE Scholarship), Ottawa, Canada; the College of Medicine of South Africa (the Phyllis Kocker/Bradlow Award), Cape Town, South Africa; and the University of KwaZulu-Natal (competitive research grant), Durban, South Africa. Dr Biccard is supported by a National Research Foundation (NRF) grant and the University of KwaZulu-Natal (competitive research grant).

Conflict of interest

Dr’s Roberts, Skinner, Biccard and Rodseth declare that they have no conflict of interest.

Compliance with Ethics Guidelines

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Perioperative Research Group, Department of Anaesthetics and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

    S. Roberts, D. Skinner & B. Biccard

  2. Perioperative Research Group, Department of Anaesthetics and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa

    R. N. Rodseth

  3. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

    R. N. Rodseth

Authors
  1. S. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Skinner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Biccard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. N. Rodseth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Roberts.

Appendix 1: Search strategy and databases

Appendix 1: Search strategy and databases

Database searches were conducted on 18 September 2012 using the OvidSP search engine (Ovid Technologies, Inc., New York, NY 2009) for the following databases:

  1. 1.

    EMBASE 1979–2012 September 17

  2. 2.

    OVID Health Star (1966–August 2012)

  3. 3.

    Ovid MEDLINE(R) In-Process and Other Non-Indexed Citations and OVID MEDLINE(R) 1946 to present

  4. 4.

    Cochrane Central Register of Controlled Trials (September 2012)

  5. 5.

    Cochrane Database of Systematic Reviews (September 2012)

The MESH search terms used in Medline, OVID Health Star, and the Cochrane data bases were (1) Positive-Pressure Respiration.mp; and (2) Wounds and Injuries.mp. The EMBASE search terms used were: (1) Thorax injury.mp; and (2) artificial ventilation.mp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roberts, S., Skinner, D., Biccard, B. et al. The role of non-invasive ventilation in blunt chest trauma: systematic review and meta-analysis. Eur J Trauma Emerg Surg 40, 553–559 (2014). https://doi.org/10.1007/s00068-013-0370-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-013-0370-7

Keywords

Search

Navigation