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Noninvasive Bilevel Positive Pressure Ventilation in Patients with Blunt Thoracic Trauma

Background: Noninvasive bilevel positive pressure ventilation (N-BiPAP) has an established role in providing respiratory support in patients with acute respiratory failure. The significant advantage of N-BiPAP is to avoid endotracheal intubation and its complications. Currently there are no data that support N-BiPAP as first-line treatment in patients with blunt thoracic trauma. Objective: To evaluate the safety and efficacy of N-BiPAP in patients with acute respiratory failure due to blunt thoracic trauma. Methods: Prospective observational study. Twenty-two patients with blunt chest trauma (mean injury severity score 26 ± 9) were studied. N-BiPAP was applied via a tight-fitting full or total-face mask, combined with regional anesthesia in all patients. Results:N-BiPAP resulted in significant changes in blood gasses, heart rate and breathing frequency at 1 h. Eighteen out of 22 patients avoided intubation and were discharged from the ICU (success group). Four patients met predefined criteria and required intubation (failure group) within 24 h after N-BiPAP. Three of the patients in the failure group survived while 1 developed septic shock and died. The acute response of oxygenation to N-BiPAP differed significantly between groups, being higher in the success group. Complications related to N-BiPAP were minor, consisting of nose bridge injury (1 patient) and gastric distention (1 patient). Conclusions: N-BiPAP administration could be a safe and effective method to improve the gas exchange in patients with acute respiratory failure due to blunt thoracic trauma.