The use of intermittent positive pressure breathing to prevent secondary pulmonary complications in patients with blunt chest wall trauma

Abstract

Introduction Patients with chest wall trauma are at high risk of developing secondary pulmonary complications (1). There is currently no treatment pathway that exists for this patient group. Aim To investigate prophylactic intermittent positive pressure breathing (IPPB) for patients with rib fractures associated with blunt chest wall trauma. Method A 3 month retrospective review of patients presenting with chest wall trauma (>3 rib fractures) showed 58% developed pneumonia requiring antibiotics, chest physiotherapy, and/or supportive ventilation. A blunt chest wall assessment tool, analgesia pathway and prophylactic IPPB protocol was developed to include patients with blunt chest wall trauma over a 10 month period. Pain scores, CXR, analgesia and oxygen requirements were recorded. All patients were assessed and prescribed IPPB for a minimum of 5 days post trauma. Results 30 patients were included over a 10 month period. On initial presentation 93% (27pts) had consolidation and 63% (19pts) collapse on CXR with extensive rib fractures (Mean = 9, Range 3-18) and an average pain score of 7/10. By day 5 100% (30pts) had improvements in oxygenation, auscultation and 0 patients required invasive ventilation. 26% (8pts) required non-invasive support and antibiotic therapy. This demonstrated a 36% reduction in incidence of pulmonary complications when compared to the retrospective data. Conclusions This small study demonstrated the use of prophylactic IPPB for patients presenting with blunt chest trauma is safe and significantly decreases the incidence of pulmonary complications when combined with a risk factor scoring chart and analgesia protocol.