High Flow Nasal Oxygenation Versus Non-invasive Ventilation for Patients With Blunt Chest Trauma
Condition: Chest Trauma
MeSH terms: Wounds and Injuries; Thoracic Injuries
Study type: Interventional

Summary: 
      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 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. 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 ARDS after chest trauma carry
      the greatest potential to reduce the substantial morbidity, mortality, and resource
      utilization associated with this syndrome.
    

Detailed description: 
      In the past years, High-flow nasal cannula oxygen (HFNC) has gained an important popularity
      among intensivest to manage patients with acute respiratory failure, filling a gap in the
      ventilatory support escalation between facemask oxygen and non-invasive or invasive
      mechanical ventilation. Interestingly, the use of HFNC was widely and rapidly adopted in
      ICUs.A unique feature of HFNC is its ability to comfortably deliver high flows of warmed
      humidified gas, 20-70 L min, with a FiO2 range of 0.21-1.0. Physiological responses to HFNC
      therapy include increases in airway pressure, end-expiratory lung volume (EELV), and
      oxygenation which are probably optimal with higher flows (60-70 L/min), while the effects on
      dead-space washout work of breathing, and respiratory rate may be obtained with intermediate
      flows (20-45 L/min).

      Many studies have found that high flow nasal oxygen is much better tolerated by patients
      compared to non-invasive ventilation, which may improve compliance. Nevertheless, there is no
      clear consensus on the treatment outcomes (such as intubation rate, escalated respiratory
      support rate, and mortality) of high flow nasal oxygenation versus non-invasive ventilation
      for patients with traumatic chest injuries.
    

Intervention name(s): high flow oxygenation
Intervention type(s): Procedure
Intervention description(s): All patients will have FiO2 started at 0.4 and titrated to maintain oxygen saturation (SpO2) ≥ 95%.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be randomly allocated into two groups; patients will receive high-flow nasal oxygenation via nasal cannula (HFNC) or continuous positive airway pressure (CPAP)
Masking: None (Open Label)
Primary purpose: Treatment