Impact of the Early Use of High-flow Nasal Cannula in Patients with Post-traumatic Lung Contusion: A Randomized Clinical Trial.

Abstract

Background: Patients with pulmonary contusion (PC) following blunt chest trauma are at risk of developing acute lung injury. High-flow nasal cannula (HFNC) is an established method for managing hypoxic respiratory failure (HRF).

Aim: This study aims to evaluate the efficacy of oxygen therapy delivered through HFNC vs venturi mask (VM) in patients with hypoxia following traumatic lung contusion, to reduce the need for intubation and ventilation.

Materials and methods: This is an open-label randomized controlled trial conducted on 120 patients with HRF following traumatic PC and a PaO₂/FiO₂ of 100-200 mm Hg. Patients were divided into two groups: Group A (60 patients) received oxygen therapy through HFNC, while group B (60 patients) received oxygen therapy through VM.

Results: High-flow nasal cannula significantly improved pulmonary oxygenation as early as 1 hour after randomization and the after with statistically significant improvement of PaO₂/FiO₂ over time (p < 0.001). However, it was associated with a nonsignificant reduction in the rate of intubation and mechanical ventilation (p = 0.255) and a nonsignificant reduction in the mortality rate (p = 0.491). The extent of PC was found to be an independent predictor of mortality (p = 0.589) and length of hospital stay (p = 0.581) by multivariate analysis.

Conclusion: The early use of HFNC is associated with a significant improvement in pulmonary oxygenation. We suggest that HFNC can be used as a first-line oxygen therapy in hypoxic patients with lung contusion following blunt chest trauma.

How to cite this article: Elsayed RG, Hafez AF, Maarouf MM, AbdElAziz FKE. Impact of the Early Use of High-flow Nasal Cannula in Patients with Post-traumatic Lung Contusion: A Randomized Clinical Trial. Indian J Crit Care Med 2025;29(2):117-124.