Hsu Jeremy Ming, Clark Peter Telford, Connell Laura Elizabeth, Welfare Matthew
Trauma Service, Westmead Hospital, Westmead, New South Wales, Australia.
Westmead Hospital Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia.
Trauma Surg Acute Care Open. 2020 Jul 7;5(1):e000460. doi: 10.1136/tsaco-2020-000460. eCollection 2020.
Patients with rib fractures require analgesia, oxygen supplementation and physiotherapy. This combination has been shown to reduce morbidity and mortality due to rib fractures. There has been movement towards the use of high-flow nasal prong (HFNP) oxygen. However there are no studies demonstrating the effectiveness of HFNP in this population. The aim of this study was to compare HFNP to venturi mask (VM) in rib fracture patients.
Randomized controlled trial. Patient population included patients with rib fractures and high-risk features (three or more rib fractures, flail segment, bilateral rib fractures, smoker or chronic obstructive pulmonary disease). Exclusion criteria included initial mechanical ventilation and contraindications to HFNP. Patients were randomized to HFNP or VM. Primary outcome was deterioration requiring mechanical invasive/non-invasive ventilation, or unplanned admission to intensive care unit. Secondary outcomes included mortality, length of stay, high dependency length of stay, comfort levels, breathing exertion levels (as measured by Borg Scale), oxygen saturation, respiratory rate, heart rate, chest X-ray and arterial blood gas parameters.
220 patients (average age 60 years and average of four rib fractures each) were randomized to HFNP (n=113) and VM (n=107). There was no statistically significant difference in the primary outcome comparing HFNP and VM (6.2% vs. 6.5%, p=1.0). There were also no statistically significant differences in the secondary outcomes except for PaCO (43.6 vs. 45.5, p=0.039).
HFNP oxygen supplementation does not appear to be more effective than VM oxygen supplementation in patients with rib fractures.
肋骨骨折患者需要镇痛、吸氧及物理治疗。已证实这种联合治疗可降低肋骨骨折所致的发病率和死亡率。目前已逐渐倾向于使用高流量鼻导管（HFNP）吸氧。然而，尚无研究证实HFNP在该人群中的有效性。本研究旨在比较HFNP与文丘里面罩（VM）用于肋骨骨折患者的效果。
随机对照试验。患者群体包括具有高风险特征的肋骨骨折患者（三根或更多肋骨骨折、连枷胸、双侧肋骨骨折、吸烟者或慢性阻塞性肺疾病患者）。排除标准包括初始机械通气及HFNP的禁忌证。患者被随机分为HFNP组或VM组。主要结局为病情恶化需要有创/无创机械通气，或意外入住重症监护病房。次要结局包括死亡率、住院时间、高依赖病房住院时间、舒适度、呼吸用力程度（采用Borg量表测量）、血氧饱和度、呼吸频率、心率、胸部X线及动脉血气参数。
220例患者（平均年龄60岁，平均每人有四处肋骨骨折）被随机分为HFNP组（n = 113）和VM组（n = 107）。比较HFNP组和VM组的主要结局，差异无统计学意义（6.2%对6.5%，p = 1.0）。除PaCO（43.6对45.5, p = 0.039）外，次要结局的差异也均无统计学意义。
对于肋骨骨折患者，HFNP吸氧似乎并不比VM吸氧更有效。
