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A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest
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  1. M Gunduz,
  2. H Unlugenc,
  3. M Ozalevli,
  4. K Inanoglu,
  5. H Akman
  1. Çukurova University Faculty of Medicine Department of Anaesthesiology Balcali, Adana, Turkey;
  1. Correspondence to:
 Dr M Gunduz
 Çukurova University Faculty of Medicine, Department of Anaesthesiology, 01330, Balcali, Adana, Turkey; hmuratcu.edu.tr

Abstract

Introduction: The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation.

Method: 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.

Results: Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO2 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).

Conclusion: Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma.

  • 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
  • NPPV, non-invasive positive pressure ventilation
  • PCA, patient controlled analgesia
  • PEEP, positive end expiratory pressure
  • RR, respiratory rate
  • TTSS, Thoracic Trauma Severity Score
  • Continuous positive airway pressure
  • intermittent positive pressure ventilation
  • length of ICU stay
  • mortality
  • patient controlled analgesia
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Footnotes

  • Competing interests: none declared

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