Noninvasive ventilation in trauma

Table 1 Contraindications to noninvasive ventilation

Trauma, deformity, facial or neurological surgery

Inability to protect airway or cooperate

High risk for aspiration and inability to clear secretions

Upper airway obstruction

Respiratory or cardiac arrest

Organ failure

Unstable cardiac arrhythmia/hemodynamic instability

Severe Encephalopathy (e.g., GCS < 10)

Severe upper gastrointestinal bleeding

Adapted from ref.[46]. GCS: Glasgow Comma Scale.

Table 2 Tabulated summary of the most significant randomized control studies depicting the use of noninvasive ventilation in posttraumatic hypoxemic respiratory failure

Ref.	No. of Patients enrolled	Study intervention per patient group	Inclusion criteria	Exclusion criteria	Analgesia	Outcomes
Bolliger et al[32]	69	36 - CPAP 33 - CPPV	Chest trauma with > 3 rib fractures; Insufficient cough mechanism	PaO2/FiO2 < 200	Lumbar epidural catheter	Duration of treatment, ICU length of stay, complications, mortality
Tanaka et al[31]	59	25 - CPAP 11 - PSSB 44 - IMV/CMV	Blunt thoracic trauma with flail chest	Flail chest injury caused by CPR	Epidural analgesia	mortality, pulmonary complications
Ferrer et al[30]	105	51 - NIV 54 - High-concentration oxygen therapy	Chest trauma with acute respiratory failure	PaCO2 > 45 mmHg; need for ETI; recent facial, esophageal, cranial trauma and surgery; ↓ GCS ( ≤ 11); hemo-dynamic instability; arrythmia/MI; > 1 organ system failure	Not defined	ICU mortality, rate of intubation, incidence of septic shock
Gunduz et al[33]	43	22 - CPAP 21 - IPPV	Flail chest; PaO2/FiO2 < 300; Acute respiratory distress	Need for ETI; hemo-dynamic instability; coma/confusion; Emergency surgery	PCA	ICU mortality, complications, improvement in oxygenation, ICU length of stay
Hernandez et al[34]	50	25 - NIV 25 - High flow oxygen mask	PaO2/FiO2 < 200 for > 8 h while receiving oxygen by high-flow mask	PaCO2 > 45 mmHg; need for emergency ETI; standard contraindications for NIV (Table 1); severe traumatic brain injury	Epidural analgesia	Intubation rate Hospital length of stay, Survival

CPAP: Continuous positive airway pressure; CPPV: Continuous positive pressure ventilation; ICU: Intensive care unit; NIV: Noninvasive ventilation; PCA: Patient controlled analgesia; IPPV: Intermittent positive pressure ventilation; CPR: Cardiopulmonary resuscitation; CMV: Continuous mandatory ventilation; IMV: Intermittent mandatory ventilation; PSSB: Pressure support on spontaneous breathing; ETI: Endotracheal intubation; GCS: Glasgow Coma Scale; MI: Myocardial infarction; PaO₂: Partial pressure of O₂ in arterial blood; FiO₂: Inspired oxygen fraction; PaCO₂: Partial pressure of CO₂ in arterial blood.