Noninvasive ventilation in chest trauma-related acute respiratory failure related to chest trauma: Efficacy and risk of pneumothorax.

PURPOSE

Current guidelines recommend noninvasive ventilation (NIV) for chest trauma patients with acute respiratory failure. This study aimed to identify factors predictive of NIV failure and assess the risk of pneumothorax during NIV.

METHODS

This retrospective study was conducted in four adult ICUs from January 2010 to January 2021. Patients were included if they were admitted with chest trauma and treated with NIV for acute respiratory failure.

RESULTS

A total of 134 patients were included in the study. At NIV initiation the mean PaO2/FiO2 ratio was 251 mm Hg and 30% of patients were hypercapnic. NIV failure occurred in 33 patients (24.6%). In multivariate analysis, no independent factors were significantly associated with failure. Among the 79 patients without a pneumothorax before NIV, 1 patient (1.3%) developed a pneumothorax under NIV. 55 patients had a pneumothorax before NIV, 33 were treated with a chest tube, and 2 (6%) experienced recurrence of pneumothorax during NIV. For the remaining 22 patients with minimal pneumothorax monitored without chest tube, 3 (13.6%) had worsening of the pneumothorax under NIV.

CONCLUSIONS

In this multicenter study on chest trauma patients, NIV success was observed in approximately 75% of cases. No independent predictive factors for NIV failure were identified. While the risk of pneumothorax worsening under NIV was low, careful monitoring is essential, particularly when managing pneumothorax conservatively without chest tube placement.