The continuous positive airway pressure (CPAP)‎ for ventilation for patients with multiple fracture ribs

الملخص EN

The role of non-invasive positive pressure ventilation delivered through a face mask in patient 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 tow , treatment groups: the ET group (n=27) received mechanical ventilation with ETI, 52 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 Pa02 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 IPPV (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 Abbrevations : CLT, Computed Lung Tomography; CPAP, Continuous Positive Airway Pressure; ETI, Endotracheal Intubation; ETMV, Endotracheal Intubation and Mechanical Ventilation; ICU, Intensive Care Unit; IPPV, Intermittent Positive Pressure Ventilation, NIPPV, Non-Invasive Positive Pressure Ventilation; PCA, Patient Controlled Analgesia, PEEP, Positive End Expiratory Pressure; RR, Respiratory Rate; TTSS, Thoracic Trauma Severity Score.