Chest
Clinical Investigations in Critical CareTreatment of Multiple Rib Fractures: Randomized Controlled Trial Comparing Ventilatory with Nonventilatory Management
Section snippets
Population
Between January 1988 and March 1989, 70 patients admitted to our respiratory ICU with multiple rib fractures in NIC were sequentially randomized pairwise24 to either CPAP mask treatment combined with regional analgesia or to endotracheal intubation and ventilation. Informed consent was obtained. The study had been approved by the University of Stellenbosch Faculty of Medicine Ethics Committee. Patients with NIC were enrolled in the study according to the criteria listed in the following
RESULTS
Of the 70 patients entered into the trial, one in the group with CPAP had to be excluded because serial chest x-ray films showed fewer than four rib fractures. Finally, 36 patients were treated by CPAP mask, and 33 by endotracheal intubation and mechanical ventilation. The groups were comparable in respect to sex, age, grade of dyspnea prior to the injury, preexisting pulmonary disease, smoking habits, the FVC before onset of treatment, and the PaO2 with 40 percent oxygen by mask on admission (
DISCUSSION
In this study, we conducted a randomized controlled trial to compare treatment by CPAP mask combined with regional analgesia to endotracheal intubation and mechanical ventilation with PEEP in patients with multiple rib fractures in NIC. In our sample, we could demonstrate that treatment by CPAP mask proved to be much shorter and had fewer complications than intubation and mechanical ventilation.
Previous studies showed that NIC with multiple rib fractures could be managed without intubation of
ACKNOWLEDGMENTS
We thank Prof. R. Stewart and Mrs. J. Barnes for reviewing the article, Prof. D. Kotze for statistical analysis, and E. Badenhorst and B. Karg for compiling the manuscript.
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2018, InjuryCitation Excerpt :Moreover, when compared to mechanical ventilation in two RCTs, CPAP was reported to have lower mortality and pneumonia rates by up to 28% and 34% respectively [24,29]. In one of the aforementioned RCTs comparing CPAP to mechanical ventilation (MV), the patients received regional analgesia as well as CPAP, which was not provided to the comparison mechanical ventilation group, which may have affected their results [24]. However, the second RCT of 43 patients with five or more rib fractures also reported lower pneumonia and mortality rates [29].
Manuscript received July 20; revision accepted October 2