Invasive and sequential non-invasive mechanical ventilation in flail chest combined with pulmonary contusion

Objective:To explore the effect of invasive and sequential non-invasive mechanical ventilation in flail chest combined with pulmonary contusion.Methods:Twenty-four patients with flail chest and pulmonary contusion were randomly divided into invasive and sequential non-invasive mechanical ventilation(MV)group and control group.The early extubation was conducted and followed by non-invasive MV via facial mask with S/T mode immediately when the ventilated frequency was decreased to 10,PSV to 10 cmH2O and PEEP to 2 cmH2O in 12 cases(study group).Invasive MV were still performed in all patients in the other 12 cases(control group) when the ventilated frequency was decreased to 5 and PSV to 7 cmH2O,PEEP to 0 cmH2O,then extubate and stop mechanical ventilation.The respiratory rate(RR),heart rate(HR),oxygenation index,arterial partial pressure of carbon dioxide(PaCO2),the systolic blood pressure(SBP),the blood pH,the duration of ICU stay and the incidence of ventilation associated pneumonia(VAP) in different time were recorded.Results:Compared the invasive and sequential non-invasive mechanical ventilation group with the control group,the occurrence of VAP(5 vs 11,P0.05),the total time of mechanical ventilation(15±3 d vs 18±2 d,P 0.05)and the time of patient's stay in the ICU had significant difference(17±3 d vs 20±2 d,P 0.05).Conclusion:In patients with flail chest and pulmonary contusion,sequential non-invasive following invasive mechanical ventilation can decrease the incidence of VAP,duration of ICU stay and the total duration of ventilatory support.