Dufraigne Antonin, Bonjean Paul, Gergele Laurent, Morel Jerome, Thiery Guillaume, Beuret Pascal
Department of Intensive Care Medicine, Saint Etienne University Hospital, 42100, Saint-Etienne, France.
Department of Medical Information and Public Health, Roanne Hospital, 42300, Roanne, France.
Eur J Trauma Emerg Surg. 2025 May 14;51(1):204. doi: 10.1007/s00068-025-02879-7.
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.
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.
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.
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.
当前指南推荐对急性呼吸衰竭的胸部创伤患者采用无创通气（NIV）。本研究旨在确定无创通气失败的预测因素，并评估无创通气期间气胸的风险。
本回顾性研究于2010年1月至2021年1月在四个成人重症监护病房进行。纳入因胸部创伤入院并接受无创通气治疗急性呼吸衰竭的患者。
本研究共纳入134例患者。开始无创通气时，平均动脉血氧分压/吸入氧分数值（PaO2/FiO2）为251 mmHg，30%的患者存在高碳酸血症。33例患者（24.6%）无创通气失败。多因素分析显示，无独立因素与失败显著相关。在无创通气前无气胸的79例患者中，1例（1.3%）在无创通气期间发生气胸。55例患者在无创通气前存在气胸，33例接受胸腔闭式引流治疗，2例（6%）在无创通气期间气胸复发。其余22例少量气胸患者未行胸腔闭式引流监测，3例（13.6%）在无创通气期间气胸加重。
在这项针对胸部创伤患者的多中心研究中，约75%的病例无创通气成功。未发现无创通气失败的独立预测因素。虽然无创通气期间气胸加重的风险较低，但仔细监测至关重要，尤其是在未放置胸腔闭式引流保守治疗气胸时。
