Sedation for Non-invasive Ventilation in Blunt Chest Trauma
Condition: Chest Trauma
MeSH terms: Wounds and Injuries; Thoracic Injuries
Study type: Interventional

Summary: 
      Effectiveness of sedation using dexmedetomidine and ketamine to facilitate non-invasive
      ventilation sessions which improve overall outcome after blunt chest trauma
    

Detailed description: 
      Chest trauma remains an issue for health services for both severe and apparently mild trauma
      management. Severe chest trauma is associated with high mortality and is considered liable
      for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with
      significant morbidity especially in patients with preexisting conditions. Thus, whatever the
      severity, a fast-acting strategy must be organized.

      Blunt traumas are commonly secondary to motor vehicle accidents, falls, and crush or blast
      injuries. They are the most common type of thoracic trauma, accounting for over 90%, and are
      often associated with rib fractures, haemothorax, pneumothorax, and pulmonary contusions.

      In order to improve the prognosis of patients with severe chest trauma, early and continuous
      application of non-invasive mechanical ventilation (NIV) can indeed reduce the need for
      intubation and shorten intensive care unit length-of-stay Among different mechanisms, the
      early use of positive end-expiratory pressure after chest trauma, when feasible, seems
      mandatory to optimize oxygenation and improve clinical outcomes. Indeed, interventions aimed
      at preventing acute respiratory distress syndrome (ARDS) after chest trauma carry the
      greatest potential to reduce the substantial morbidity, mortality, and resource utilization
      associated with this syndrome.

      Notably, pain control seems a crucial endpoint in our success to deliver non-invasive
      ventilation to patients with chest trauma, when feasible as a pivotal component of patient
      care after chest trauma, along with non-invasive ventilation. In this context, the role of
      intensivist doctors is thus to provide optimal control of chest wall pain, respiratory
      comfort, agitation, and anxiety as a prerequisite to reduce the incidence of NIV failure in
      this trauma population.

      In this context, dexmedetomidine could be an alternative to improve NIV tolerance.
      Dexmedetomidine is a short-acting alpha-2 adrenoreceptor agonist that provides sedation and
      analgesia with no significant respiratory depression and a reduced risk of delirium.

      Ketamine has several advantages compared with conventional sedatives such as preserving
      pharyngeal and laryngeal protective reflexes, lowering airway resistance, increasing lung
      compliance, and being less likely to produce respiratory depression. It causes sympathetic
      stimulation, which is also unlike other sedatives and analgesics.

      However, no studies have estimated the superiority of dexmedetomidine or Ketamine to improve
      analgesia and non-invasive ventilation tolerance in patients with blunt chest

      The patients will be randomly allocated into 3 groups, the allocation of the treatment order
      will determine by means of a computer-generated random table.

      Group C: will receive placebo infusion (0.9% sodium chloride solution) Group D: will receive
      dexmedetomidine infusion Group K: will receive ketamine infusion
    

Intervention name(s): Dexmedetomidine Hydrochloride; Ketamine Hydrochloride; Placebo
Intervention type(s): Drug; Drug; Drug
Intervention description(s): is a sympatholytic drug that acts as an agonist of α2-adrenergic receptors in certain parts of the brain.; Ketamine is an NMDA receptor antagoni; Normal saline
Other intervention name(s): Precedex; Ketalar; Nacl .9%
Intervention MeSH terms: Dexmedetomidine; Ketamine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Sedation - noninvasive ventilation-ketamine- dexmedetomidine