ASSISTED RESPIRATION USING CPAP VIA FACE-MASK IN PATIENTS WITH BLUNT CHEST TRAUMA - AN ALTERNATIVE TO INTUBATION AND MECHANICAL VENTILATION

Intubation and Positive End Expiratory Pressure Ventilation (PEEP) is a well established therapeutic strategy for impaired lung function, pa rticularly following blunt chest trauma. Complications of this regime are however also well known and pose the question why non-invasive for ms of respiratory assistance such as Continuous Positive Airway Pressu re (CPAP) have only gained minor popularity. In a prospective study, 3 0 patients who had suffered blunt chest trauma were treated with CPAP administered by mask. The regime consisted of continuous administratio n of CPAP by a face-mask, with gradually increasing periods of spontan eous breathing. Initially a FiO(2) of 0.33 (range 0.28-0.38) proved ne cessary. The initial CPAP level was 7 mbar (range 5-8) with an (Assist ed Spontaneous Breathing) ASB of 15 mbar (range 13-18). FiO(2) and CPA P/ASB levels were subsequently gradually reduced until no longer neces sary. In all patients intubation and ventilation was avoided by this r egimen. The treatment was well accepted by all patients and common ven tilation associated complications such as pneumonia did not occur. In comparison with the former standard method of treatment the average IC U stay was dramatically reduced, principally due to not having to grad ually wean patients from ventilation and sedation. Other positive bene fits include normal communication and feeding with active early mobili sation leading to faster recovery, both physical and psychological. We conclude that non-invasive respiratory techniques should be used more frequently and recommend further studies are undertaken to define the indications.