Related Experiment Video
Updated: Mar 12, 2026
Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General
Bethany A Nyland1, Sarah K Spilman2, Meghan E Halub1
1General Surgery Residency Program, Iowa Methodist Medical Center, Des Moines, Iowa.
Insights
A proactive respiratory protocol for blunt chest trauma patients reduced hospital stays by 1.5 days and eliminated intensive care unit (ICU) admissions. This strategy effectively identifies at-risk patients and prevents pulmonary complications.
Area of Science:
- Traumatology
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Blunt chest trauma poses significant risk for respiratory complications.
- Evidence on prophylactic respiratory therapy effectiveness in trauma patients is contradictory.
- A proactive protocol was developed to manage respiratory risks in trauma patients on general wards.
Purpose of the Study:
- To assess the effectiveness of a proactive respiratory protocol in preventing pulmonary complications post-blunt chest trauma.
- To identify at-risk trauma patients and administer timely respiratory therapies.
- To prevent patient deterioration requiring intensive care unit (ICU) transfer.
Main Methods:
- A Level 1 trauma center implemented a respiratory therapy evaluation protocol for admitted patients.
- Eligible patients received prophylactic treatments like MetaNeb, Vest, or EzPAP therapy.
- The protocol underwent phased evaluation, with Phase 2 featuring improved adherence and refined inclusion criteria (e.g., ≥3 rib fractures, pulmonary contusion, lung disease exacerbation, or age ≥65 with immobility).
Main Results:
- The protocol eliminated unplanned ICU admissions.
- Hospital stay was significantly reduced by approximately 1.5 days, independent of injury severity.
- Direct ward admissions from the emergency department increased, bypassing the ICU.
- Bronchodilator use showed a non-significant decrease.
Conclusions:
- A preventive respiratory protocol demonstrates significant benefits for trauma patient outcomes.
- Implementation of the protocol reduced overall hospital length of stay.
- The protocol effectively prevented unplanned ICU admissions for respiratory complications.
Background:
Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma patients at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU.
Methods:
Trauma patients received a respiratory therapy evaluation at the time of admission to a general in-patient ward at a Level 1 trauma center. If subjects met protocol inclusion criteria, they received prophylactic respiratory treatments, primarily MetaNeb therapy, Vest therapy, or EzPAP. Multiple phases were included to evaluate the effectiveness of the protocol, with 50 subjects in each phase: a pre-protocol phase before adoption of the protocol; phase 1, which was found to have low physician adherence and overly broad inclusion criteria; and phase 2, with improved adherence and narrower inclusion criteria. Study inclusion criteria mirror the protocol criteria from phase 2: ≥3 rib fractures; pulmonary contusion; exacerbation of COPD, asthma, or other lung disease; or age ≥65 y with expected immobility of ≥48 h.
Results:
The respiratory protocol was associated with an elimination of unplanned admissions to the ICU. After controlling for injury severity and other important clinical factors, receiving the protocol significantly decreased hospital stay by approximately 1.5 d. More subjects were admitted from the emergency department directly to the ward, avoiding the ICU. Bronchodilator use also decreased, although the result did not reach statistical significance.
Conclusions:
Study results suggest that a preventive respiratory protocol had a beneficial effect on patient outcomes; receiving the protocol reduced hospital days and eliminated unplanned admission to the ICU.
More Related Videos
Related Concept Videos
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:23Acute Respiratory Failure-IV
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management