Noninvasive ventilation in chest trauma-related acute respiratory failure related to chest trauma: Efficacy and risk of pneumothorax.

IF 1.9 3区医学 Q2 EMERGENCY MEDICINE

European Journal of Trauma and Emergency Surgery Pub Date : 2025-05-14 DOI:10.1007/s00068-025-02879-7

Antonin Dufraigne, Paul Bonjean, Laurent Gergele, Jerome Morel, Guillaume Thiery, Pascal Beuret

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引用次数: 0

Abstract

Purpose: Current guidelines recommend noninvasive ventilation (NIV) for chest trauma patients with acute respiratory failure. This study aimed to identify factors predictive of NIV failure and assess the risk of pneumothorax during NIV.

Methods: This retrospective study was conducted in four adult ICUs from January 2010 to January 2021. Patients were included if they were admitted with chest trauma and treated with NIV for acute respiratory failure.

Results: A total of 134 patients were included in the study. At NIV initiation the mean PaO2/FiO2 ratio was 251 mm Hg and 30% of patients were hypercapnic. NIV failure occurred in 33 patients (24.6%). In multivariate analysis, no independent factors were significantly associated with failure. Among the 79 patients without a pneumothorax before NIV, 1 patient (1.3%) developed a pneumothorax under NIV. 55 patients had a pneumothorax before NIV, 33 were treated with a chest tube, and 2 (6%) experienced recurrence of pneumothorax during NIV. For the remaining 22 patients with minimal pneumothorax monitored without chest tube, 3 (13.6%) had worsening of the pneumothorax under NIV.

Conclusions: In this multicenter study on chest trauma patients, NIV success was observed in approximately 75% of cases. No independent predictive factors for NIV failure were identified. While the risk of pneumothorax worsening under NIV was low, careful monitoring is essential, particularly when managing pneumothorax conservatively without chest tube placement.

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无创通气治疗胸外伤相关急性呼吸衰竭：气胸的疗效和风险

目的：目前的指南推荐无创通气（NIV）用于急性呼吸衰竭的胸外伤患者。本研究旨在确定无创通气失败的预测因素，并评估无创通气期间气胸的风险。方法：2010年1月至2021年1月对4例成人icu进行回顾性研究。如果患者因胸部外伤入院并因急性呼吸衰竭使用NIV治疗，则纳入该研究。结果：共纳入134例患者。在NIV开始时，平均PaO2/FiO2比值为251 mm Hg， 30%的患者高碳酸血症。NIV失效33例（24.6%）。在多变量分析中，没有独立因素与失败显著相关。在79例无气胸的患者中，1例（1.3%）在NIV下发生气胸。55例患者在NIV前有气胸，33例接受胸管治疗，2例（6%）在NIV期间再次发生气胸。其余22例无胸管监测轻度气胸患者中，3例（13.6%）在无创通气下气胸恶化。结论：在这项针对胸外伤患者的多中心研究中，约75%的病例成功使用了NIV。没有发现NIV失败的独立预测因素。虽然在NIV下气胸恶化的风险很低，但仔细监测是必要的，特别是在保守治疗气胸而不放置胸管的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Trauma and Emergency Surgery 医学-急救医学

CiteScore

4.50

自引率

14.30%

发文量

311

审稿时长

3 months

期刊介绍： The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.