PURPOSE: Pulmonary contusion is considered to be one of the most common blunt thoracic injuries. The clinical course can be severe with early hypoxemic respiratory failure. The purpose of the study is to assess the value of early application of continous positive airway pressure (CPAP) mask to hypoxemic patients with blunt chest trauma in the first 24 hours, considering the number of intubations, rate of pneumonia, and hospital days.
METHODS: Diagnosis of lung contusion: Signs of blunt chest injury on physical examination and imaging studies showing evidence of parenchymal lung injury, fractured 3 or more ribs in plain chest x-ray or CT scan. Inclusion criteria: adult patients with the diagnosis of lung contusion and pO2/FiO2<300 on room air.Randomization: study group = CPAP provided by a CPAP mask for a minimum of 24 hours.Control group = Treatment with supplemental oxygen via non-rebreather face mask (NRB). End–points: need of endotracheal intubation. Reaching pO2/FiO2>300. Data: SpO2, ABGs, vital signs, ICU & hospital days.
RESULTS: The study is done as a pilot study (total number 29 patients). 2 groups randomized: group one (n=15) randomized to the CPAP and group two (n=14) randomized to NRB mask. 2 cases of pneumonia in both groups. 3 cases of intubation in both groups. It was noted that one patient randomized to NRB had stayed 37 days in the hospital until being intubated. The average length of stay for CPAP patients was 16.40 days, and that of the NRB patients was 11.54 days.
CONCLUSION: There was no statistical significance between the two groups (CPAP vs. NRB) regarding incidence of pneumonia and number of intubations. There was no statistical significance between the two groups regarding average worse PaO2 value while in trauma resuscitation and average ICU stay.
CLINICAL IMPLICATIONS: This study has shown that CPAP and NRB are both effective means of treatment producing similar results. Further studies using larger sample size are needed to determine if early application of CPAP improves outcome in hypoxemic patients with blunt chest trauma.
DISCLOSURE: Karim Abouelenin, None.