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Original Research: CRITICAL CARE MEDICINE |

Noninvasive Ventilation Reduces Intubation in Chest Trauma-Related Hypoxemia: A Randomized Clinical Trial

Gonzalo Hernandez, MD, PhD; Rafael Fernandez, MD, PhD; Pilar Lopez-Reina, MD; Rafael Cuena, MD; Ana Pedrosa, MD; Ramon Ortiz, MD; Paloma Hiradier, MD
Author and Funding Information

From the Intensive Care Unit (Drs Hernandez, Lopez-Reina, Pedrosa, and Ortiz), Investigation Unit (Dr Cuena), and Anesthesia Department (Dr Hiradier), Hospital Virgen de la Salud, Toledo; and the Intensive Care Unit (Dr Fernandez), Fundació Althaia, Manresa, Spain.

Correspondence to: Gonzalo Hernández Martínez, MD, PhD, Critical Care Medicine, Hospital Virgen de la Salud, Toledo, Mezquite n°12, 6°A, 28045, Madrid, Spain; e-mail: ghernandezm@telefonica.net


Funding/Support: This study was supported in part by Consejería de Sanidad de Castilla-La Mancha [Grant 06001-00 ICS Talavera] and Fundación de Investigación Médica Mutua Madrileña Automovilística [Grant 06/06/2004 n°65].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):74-80. doi:10.1378/chest.09-1114
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Background:  Guidelines for noninvasive mechanical ventilation (NIMV) recommend continuous positive airway pressure in patients with thoracic trauma who remain hypoxic despite regional anesthesia. This recommendation is rated only by level C evidence because randomized controlled trials in this specific population are lacking. Our aim was to determine whether NIMV reduces intubation in severe trauma-related hypoxemia.

Methods:  This was a single-center randomized clinical trial in a nine-bed ICU of a level I trauma hospital. Inclusion criteria were patients with Pao2/Fio2<200 for >8 h while receiving oxygen by high-flow mask within the first 48 h after thoracic trauma. Patients were randomized to remain on high-flow oxygen mask or to receive NIMV. The interface was selected based on the associated injuries. Thoracic anesthesia was universally supplied unless contraindicated. The primary end point was intubation; secondary end points included length of hospital stay and survival. Statistical analysis was based on multivariate analysis.

Results:  After 25 patients were enrolled in each group, the trial was prematurely stopped for efficacy because the intubation rate was much higher in controls than in NIMV patients (10 [40%] vs 3 [12%], P = .02). Multivariate analysis adjusted for age, gender, chronic heart failure, and Acute Physiology and Chronic Health Evaluation II at admission revealed NIMV as the only variable independently related to intubation (odds ratio, 0.12; 95% CI, 0.02-0.61; P = .01). Length of hospital stay was shorter in NIMV patients (14 vs 21 days P = .001), but no differences were observed in survival or other secondary end points.

Conclusion:  NIMV reduced intubation compared with oxygen therapy in severe thoracic trauma-related hypoxemia.

Trial registration:  clinicaltrials.gov; identifier: NCT 00557752.

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