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World J Crit Care Med. Feb 4, 2015; 4(1): 47-54
Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.47
Noninvasive ventilation in trauma
Marcin K Karcz, Peter J Papadakos
Marcin K Karcz, Peter J Papadakos, Department of Anesthesiology, University of Rochester, Rochester, NY 14642, United States
Peter J Papadakos, Division of Critical Care Medicine, Departments of Surgery and Neurosurgery, University of Rochester, Rochester, NY 14642, United States
Author contributions: Karcz MK and Papadakos PJ both contributed to this paper.
Conflict-of-interest: Dr. Peter J Papadakos and Dr. Marcin K Karcz have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter J Papadakos, MD, FCCP, FCCM, Director, Division of Critical Care Medicine, Departments of Surgery and Neurosurgery, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States. peter_papadakos@urmc.rochester.edu
Telephone: +1-585-2752141 Fax: +1-585-2447271
Received: September 29, 2014
Peer-review started: October 2, 2014
First decision: October 28, 2014
Revised: November 3, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 4, 2015
Processing time: 135 Days and 9 Hours
Abstract

Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma.

Keywords: Acute respiratory distress syndrome; Noninvasive ventilation; Pulmonary contusion; Respiratory failure; Trauma

Core tip: The use of noninvasive ventilation is widely recognized as a suitable way to avoid intubation and its associated side effects. Noninvasive ventilation allows increased flexibility in the application and discontinuation of ventilator assistance and preserves airway defense mechanisms. The application of noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia, thereby potentially decreasing intensive care unit length of stay and preventing respiratory complications. In this review article, we summarize the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma.