Noninvasive ventilation in chest trauma: Systematic review and meta-analysis

Salvatore Coppola, Cesare Gregoretti, Chiumello, Consonni, Coppola, Froio, Gregoretti

Research output: Contribution to journalArticle

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Abstract

Purpose: Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy. Methods: We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis. Results: Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09-0.71, p = 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections. Conclusions: These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.
Original languageEnglish
Pages (from-to)1171-1180
Number of pages10
JournalIntensive Care Medicine
Volume39
Publication statusPublished - 2013

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Noninvasive Ventilation
Meta-Analysis
Thorax
Wounds and Injuries
Respiratory Insufficiency
Intubation
Mortality
Continuous Positive Airway Pressure
Bibliography
Artificial Respiration
PubMed
Observational Studies
Ventilation
Length of Stay
Randomized Controlled Trials
Retrospective Studies
Confidence Intervals
Oxygen
Pressure
Incidence

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Noninvasive ventilation in chest trauma: Systematic review and meta-analysis. / Coppola, Salvatore; Gregoretti, Cesare; Chiumello; Consonni; Coppola; Froio; Gregoretti.

In: Intensive Care Medicine, Vol. 39, 2013, p. 1171-1180.

Research output: Contribution to journalArticle

Coppola, S, Gregoretti, C, Chiumello, Consonni, Coppola, Froio & Gregoretti 2013, 'Noninvasive ventilation in chest trauma: Systematic review and meta-analysis', Intensive Care Medicine, vol. 39, pp. 1171-1180.
Coppola, Salvatore ; Gregoretti, Cesare ; Chiumello ; Consonni ; Coppola ; Froio ; Gregoretti. / Noninvasive ventilation in chest trauma: Systematic review and meta-analysis. In: Intensive Care Medicine. 2013 ; Vol. 39. pp. 1171-1180.
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AB - Purpose: Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy. Methods: We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis. Results: Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09-0.71, p = 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections. Conclusions: These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.

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