What is the role of noninvasive ventilation (NIV) in the treatment of rib fractures?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

With rib fractures (traumatic, with nonpenetrating chest injuries), note the following:

  • Older single report using low-level CPAP (5 cm water)

  • Fewer episodes of pneumonia, duration of hospitalization

  • No mortality benefit: Hernandez et al found that in patients with hypoxemia related to severe thoracic trauma, noninvasive mechanical ventilation reduced intubation rates. In a randomized clinical trial, patients with PaO2/FiO2 ratio of less than 200 for more than 8 hours while receiving oxygen by high-flow mask within the first 48 hours after thoracic trauma were randomized to remain on high-flow oxygen mask or to receive noninvasive mechanical ventilation. The trial was halted after 25 patients were enrolled in each group because the intubation rate was much higher in controls than in noninvasive mechanical ventilation patients (40% vs 12%, P = .02). In addition, length of hospital stay was shorter in noninvasive mechanical ventilation patients (14 vs 21 d, P = .001); however, no difference in survival was observed. [64]


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