Xirouchaki N, Kondoudaki E, Anastasaki M, Alexopoulou C, Koumiotaki S, Georgopoulos D
Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.
Respiration. 2005 Sep-Oct;72(5):517-22. doi: 10.1159/000086501. Epub 2005 Jul 1.
Noninvasive bilevel positive pressure ventilation (N-BiPAP) has an established role in providing respiratory support in patients with acute respiratory failure. The significant advantage of N-BiPAP is to avoid endotracheal intubation and its complications. Currently there are no data that support N-BiPAP as first-line treatment in patients with blunt thoracic trauma.
To evaluate the safety and efficacy of N-BiPAP in patients with acute respiratory failure due to blunt thoracic trauma.
Prospective observational study. Twenty-two patients with blunt chest trauma (mean injury severity score 26 +/- 9) were studied. N-BiPAP was applied via a tight-fitting full or total-face mask, combined with regional anesthesia in all patients.
N-BiPAP resulted in significant changes in blood gasses, heart rate and breathing frequency at 1 h. Eighteen out of 22 patients avoided intubation and were discharged from the ICU (success group). Four patients met predefined criteria and required intubation (failure group) within 24 h after N-BiPAP. Three of the patients in the failure group survived while 1 developed septic shock and died. The acute response of oxygenation to N-BiPAP differed significantly between groups, being higher in the success group. Complications related to N-BiPAP were minor, consisting of nose bridge injury (1 patient) and gastric distention (1 patient).
N-BiPAP administration could be a safe and effective method to improve the gas exchange in patients with acute respiratory failure due to blunt thoracic trauma.
无创双水平正压通气（N-BiPAP）在为急性呼吸衰竭患者提供呼吸支持方面已确立了作用。N-BiPAP的显著优势在于避免气管插管及其并发症。目前尚无数据支持将N-BiPAP作为钝性胸部创伤患者的一线治疗方法。
评估N-BiPAP对钝性胸部创伤所致急性呼吸衰竭患者的安全性和有效性。
前瞻性观察研究。研究了22例钝性胸部创伤患者（平均损伤严重度评分26±9）。所有患者均通过紧密贴合的全脸或全面罩应用N-BiPAP，并联合区域麻醉。
N-BiPAP在1小时时导致血气、心率和呼吸频率发生显著变化。22例患者中有18例避免了插管并从重症监护病房出院（成功组）。4例患者符合预定义标准，在N-BiPAP治疗后24小时内需要插管（失败组）。失败组中有3例患者存活，1例发生感染性休克并死亡。两组间N-BiPAP对氧合的急性反应差异显著，成功组更高。与N-BiPAP相关的并发症轻微，包括鼻梁损伤（1例患者）和胃扩张（1例患者）。
应用N-BiPAP可能是改善钝性胸部创伤所致急性呼吸衰竭患者气体交换的一种安全有效的方法。
