Noninvasive ventilation in adults with blunt chest trauma: A meta-analysis of randomized clinical trials

Noninvasive ventilation (NIV) is used in patients with post-traumatic respiratory failure, however, previous reviews indicate that its effects remain uncertain due to limited data.

To evaluate the effects of NIV on mortality, complications, infection, and intensive care unit (ICU) and hospital length of stay in adult patients with blunt chest trauma.

MEDLINE (PubMed), EMBASE, Cochrane CENTRAL, Web of Science, PEDro and Scielo were searched from inception to February 2024. Randomized clinical trials comparing NIV with invasive mechanical ventilation (IMV) or oxygen therapy for respiratory failure in adults with blunt chest trauma were included. The outcomes analyzed were mortality, complications, infections, and length of stay in the ICU. Risk of bias was assessed using the RoB 2.0. Certainty of evidence was evaluated according to Grading of Recommendation, Assessment, Development and Evaluation (GRADE).

Six studies (300 patients) were included. Meta-analysis showed that NIV likely reduces mortality (5 studies, Odds Ratio [OR] = 0.15; 95%CI 0.06, 0.37; moderate certainty of evidence) compared with IMV. NIV may reduce complications (5 studies; OR= 0.10, 95%CI 0.05, 0.20) and infections (4 studies; OR = 0.11, 95%CI: 0.05, 0.24) (moderate certainty of evidence for both). For length of stay in the ICU, NIV may reduce the number of days in the ICU (5 studies; mean difference = -2.29 days; 95%CI -3.78, -0.80; low certainty of evidence) compared with IMV.

NIV has the potential to reduce mortality, complications, infections, and ICU length of stay, compared to IMV in patients with respiratory failure after blunt chest trauma.