Non-invasive Respiratory Support in Blunt Chest Injury

Objective. To optimize the results of treatment in patients with acute respiratory failure (ARF) due to lung contusion, by using the methods of non-invasive mask respiratory support.

Materials and methods. The study covered 31 patients with severe blunt chest injury, multiple costal fractures, and hypoxemic ARF. The patients underwent assisted ventilation (AV) in the CPAP+PSV mode through a facial or nasal mask. Physiological parameters were recorded during non-invasive mask ventilation (NIMV) in the stepwise fashion. A control group comprised 25 patients with the similar severity of injury and ARF who were given conventional AV.

Results. In 67.7% of the study group patients, NIMV was effective in improving oxygenation and external respiration, without exerting negative hemodynamic effects. Endotracheal intubation and AV could be avoided in these patients. Comparison of the study and control groups revealed a significant reduction in the incidence of secondary pneumonias in the NIMV group and in the duration of treatment. Mask ventilation could decrease mortality from 44% in the control group to 9.7% in the NIMV group.

Conclusion. NIMV applied to patients with hypoxemic ARF in the presence of lung contusion improves pulmonary function and, in the bulk of patients, allows endotracheal intubation and AV and consequently their associated complications. When mask ventilation is employed, management of patients becomes shorter and simpler and mortality rates substantially decrease. 

1. Таланов Е. В. Опыт лечения закрытых травм груди. В кн.: Реабилитация больных с травмами и заболеваниями опорно-двигательной системы. Сб. тр. / Под ред. С. Е. Львова. Иваново; 1996; Кн.3. 114—116.

2. Муковников А. С., Долинская Л. Н. Лечение осложненной закрытой травмы грудной клетки. В кн.: Актуал. вопр. науч.-практ. медицины. Материалы межобластной науч. конф. Орел; 1997. 158—161.

3. Деркачева Л. В., Сазонов К. Н. Основные направления лечебной тактики у пострадавших с тяжелой закрытой травмой груди. В кн.: Актуал. пробл. сердечно-сосудистой, легочной и абдоминальной хирургии: Сб. тр. науч. конф., посвящ. 95-летию со дня рождения акад. РАМН Ф. Г. Углова. М.; 1999. 51—52.

4. Шапот Ю. Б., Селезнев С. А., Новиков А. С., Алекперов У. К. Современные проблемы и аспекты сочетанной травмы груди, сопровождающейся шоком. В кн.: Общая и неотложная хирургия: Респ. межведомственный сб. Минздрава УССР. 1991; Вып. 21. 54—59.

5. Бисенков Л. Н., Кочергаев О. В. Диагностика и лечение ушибов легких при закрытых сочетанных травмах груди. Грудная и сердечно-сосудистая хирургия 1998; 3: 43—47.

6. Bolliger C. T., Van Eeden S. F. Treatment of multiple rib fractures. Randomized controlled trial comparing ventilatory with nonventilatory management. Chest 1990; 97: 943—948.

7. Linton D. M., Potgieter P. D. Conservative management of blunt chest trauma. S. Afr. Med. J. 1982; 61: 917—919.

8. Balci A. E., Balci T. A., Eren S. et al. Unilateral post-traumatic pulmonary contusion: findings of a review. Surg. Today 2005; 35: 205—210.

9. Davignon K., Kwo J., Bigatello L. M. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004; 70: 193—199.

10. Юревич В. М. Вспомогательная неинвазивная вентиляция легких: Диссертация в виде науч. докл. на соискание ученой степени д-ра мед. наук. М.; 1997.

11. Hurst J. M., DeHaven C. B., Branson R. D. Use of CPAP mask as the sole mode of ventilatory support in trauma patients with milt to moderate respiratory insufficiency. J. Trauma 1985; 25: 1065—1068.

12. Gregoretti C., Beltrame F., Lucangelo U. et al. Physiologic evaluation of non-invasive pressure support ventilation in trauma patients with acute respiratory failure. Intensive Care Med. 1998; 24: 785—790.

13. Vidhani K., Kause J., Parr M. Should we follow ATLS guidelines for the management of traumatic pulmonary contusion: the role of non-invasive ventilatory support. Resuscitation 2002; 52: 265—268.

14. Авдеев С. Н., Третьяков А. В., Григорянц Р. А. и др. Исследование применения неинвазивной вентиляции легких при острой дыхательной недостаточности на фоне обострения хронического обструктивного заболевания легких. Анестезиология и реаниматология 1998; 3: 45—51.

15. Brochard L., Mancebo J., Wysocki M. et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N. Engl. J. Med. 1995; 333: 817—822.

16. Kramer N., Meyer T. J., Meharg J. et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am. J. Respir. Crit. Care Med. 1995; 151: 1799—1806.

17. Plant P. K., Owen J. L., Elliott M. W. Early use of noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomized controlled trial. Lancet 2000; 355: 1931—1935.

18. Wysocki M., Tric L., Wolff M. A. et al. Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Chest 1995; 107: 761—768.

19. Delclaux C., L'Her E., Alberti C. et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive air-way pressure delivered by a face mask. JAMA 2000; 284: 2352—2360.

20. Antonelli M., Conti G., Rocco M. et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N. Engl. J. Med. 1998; 339: 429—435.

21. Confalonieri M., Potena A., Carbone G. et al. Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am. J. Respir. Crit. Care Med. 1999; 160: 1585—1591.

22. Martin T. J., Hovis J. D., Constantino J. P. et al. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am. J. Respir. Crit. Care Med. 2000; 161: 807—813.

23. Auriant I., Jallot A., Herve P. et al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am. J. Respir. Crit. Care Med. 2001; 164: 1231—1235.

24. Rocker G. M., Mackenzie M.7G., Williams B., Logan M. Noninvasive positive pressure ventilation. Successful outcome in patients with acute lung injury/ARDS. Chest 1999; 115: 173—177.

25. Smailes S. T. Noninvasive positive pressure ventilation in burns. Burns 2002; 28: 795—801.

26. Галстян Г. М., Феданов А. В., Кесельман С. А. и др. Неинвазивная вентиляция легких в лечении острой дыхательной недостаточности у иммунокомпрометированных больных. Анестезиология и реаниматология 2001; 3: 23—27.

27. Acosta B., DiBenedetto R., Rahimi A. et al. Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction. Chest 2000; 118: 1004—1009.

28. Girou E., Schortgen F., Delclaux C. et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 2000; 284: 2361—2367.

29. Ferrer M., Esquinas A., Arancibia F. et al. Noninvasive ventilation during persistent weaning failure. Am. J. Respir. Crit. Care Med. 2003; 168: 70—76.

30. Heyland D. K., Cook D. J., Dodek P. M. Prevention of ventilator-associated pneumonia: current practice in Canadian intensive care units. J. Crit. Care. 2002; 17: 161—167.