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Noninvasive ventilation in chest trauma: systematic review and meta-analysis

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Abstract

Purpose

Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis.

Results

Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09–0.71, p = 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections.

Conclusions

These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma.

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Conflicts of interest

Dr. Gregoretti received fees for lectures from Vivisol, SapoLife and Covidien. He also received fees for consultancies from Covidien and Smith Medical.

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Authors and Affiliations

  1. Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy

    D. Chiumello, S. Coppola & S. Froio

  2. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy

    D. Chiumello

  3. Dipartimento di Emergenza e Accettazione, CTO-Maria Adelaide, Città della Salute e della Scienza, Turin, Italy

    C. Gregoretti

  4. Unità Operativa di Epidemiologia, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy

    D. Consonni

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  1. D. Chiumello
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  2. S. Coppola
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  3. S. Froio
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  4. C. Gregoretti
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  5. D. Consonni
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Corresponding author

Correspondence to D. Chiumello.

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Chiumello, D., Coppola, S., Froio, S. et al. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med 39, 1171–1180 (2013). https://doi.org/10.1007/s00134-013-2901-4

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