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

2016 ◽  
Author(s):  
Rachael Moses ◽  
Thomas Flint ◽  
Victoria Mummery ◽  
Claire OFarrell ◽  
Lisa Ronson ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Chest Wall Trauma ◽  
Intermittent Positive Pressure Breathing

Blunt chest wall trauma: an overview

2019 ◽  
Vol 80 (12) ◽  
pp. 711-715
Author(s):  
Jonathan B Simon ◽  
Alex J Wickham
Keyword(s):  
Chest Wall ◽  
Management Strategies ◽  
Anaesthetic Techniques ◽  
Intercostal Nerve ◽  
Pulmonary Complications ◽  
Nerve Blocks ◽  
Chest Wall Mechanics ◽  
Rib Fixation ◽  
Chest Wall Trauma ◽  
Oral Analgesia

Trauma affecting the chest wall, even in isolation, can carry a significant morbidity and mortality and thus appropriate management is vital. Consequences of chest wall trauma may include significant pain, altered chest wall mechanics, hypoventilation, infection and respiratory failure. In order to best determine the appropriate management, risk stratification tools have been developed to identify patients at highest risk of complications who would most benefit from more invasive management strategies. Early optimization of analgesia is vital both for patient experience and to reduce the risk of pulmonary complications. The analgesic options range from multimodal oral analgesia to invasive regional anaesthetic techniques such as thoracic epidurals, paravertebral catheters, intercostal nerve blocks and fascial plane blocks. Other important considerations include provision of appropriate oxygen therapy, ventilation support and physiotherapy. For a selected group of patients with the most significant injuries, surgical rib fixation may be appropriate if chest wall mechanics are sufficiently impaired.

The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients

2020 ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Shou-Fong Shiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy.Methods: This retrospective study included 48 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two type of positive pressure devices, MI-E (n=20) or IPPB (n=28). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups.Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.9±4.96 % vs. 45.21±3.60 %, p=0.026), forced expiratory volume in one second (63.35±5.4 % vs. 45.48±3.63 %, p=0.007), and peak flow rate (68.5±5.53 % vs. 54.75±4.11 %, p=0.047). However, the incidence of chest pain was higher in the MI-E group (n=13, 65%) than in the IPPB group (n=4, 14.3%; odds ratio, 11.14, 95% confidence interval, 2.74-45.26; p=0.001). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups.Conclusion: Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with improved pulmonary function and higher incidence of chest pain.

scholarly journals The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients: A Pilot Study

2020 ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Hsiu-Fong Hsiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods: This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n=21) or IPPB (n=30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4±4.74 % vs. 46.0±3.70 %, p=0.042), forced expiratory volume in one second (62.4±5.23 % vs. 46.8±3.83 %, p=0.017), and peak flow rate (67.1±5.53 L vs. 55.7±4.44 L p=0.111). However, the incidence of chest pain was higher in the MI-E group (n=13, 61.9%) than in the IPPB group (n=4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03-0.45; p=0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion : Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

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