continuous positive airway pressure [CPAP] for ventilation for patients with multiple fracture ribs

ABSTRACT

The role of non-invasive positive pressure ventilation delivered through a face mask in patients with multiple fracture ribs is uncertain. We conducted a prospective, randomized study of continuous positive airway pressure [CPAP] given via a face mask for spontaneously breathing patients compared with intermittent positive pressure ventilation [IPPV] with endotracheal intubation [ETI] in 52 patients with multiple fracture ribs who required mechanical ventilation. The 52 mechanically ventilated patients were randomly divided into two treatment groups the ET group [n=27] received mechanical ventilation with ETI, whereas patients in the CPAP group [n=25] received CPAP via a face mask with patient controlled analgesia [PCA]. Major complications, arterial blood gas levels, length of intensive care unit [ICU] stay and ICU survival rate were recorded Nosocomial infection was diagnosed in 10 to 21 patients in the ET group, but only in 4 of 22 in the CPAP group [P=0.001]. Mean PaO 2 was significantly higher in the ET group in the first 2 days [P < 0.05]. There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received 1PPV [P < 0.01]. Non invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. This study supports the application of CPAP at least as a first line of treatment for multiple fractured ribs caused by blunt thoracic trauma