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Original research
Efficacy of high-flow nasal prong therapy in trauma patients with rib fractures and high-risk features for respiratory deterioration: a randomized controlled trial
  1. Jeremy Ming Hsu1,
  2. Peter Telford Clark2,
  3. Laura Elizabeth Connell3,
  4. Matthew Welfare1
  1. 1Trauma Service, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Westmead Hospital Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
  3. 3Department of Anaesthesia, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Mr Matthew Welfare; Matthew.Welfare{at}health.nsw.gov.au

Abstract

Background Patients with rib fractures require analgesia, oxygen supplementation and physiotherapy. This combination has been shown to reduce morbidity and mortality due to rib fractures. There has been movement towards the use of high-flow nasal prong (HFNP) oxygen. However there are no studies demonstrating the effectiveness of HFNP in this population. The aim of this study was to compare HFNP to venturi mask (VM) in rib fracture patients.

Methods Randomized controlled trial. Patient population included patients with rib fractures and high-risk features (three or more rib fractures, flail segment, bilateral rib fractures, smoker or chronic obstructive pulmonary disease). Exclusion criteria included initial mechanical ventilation and contraindications to HFNP. Patients were randomized to HFNP or VM. Primary outcome was deterioration requiring mechanical invasive/non‐invasive ventilation, or unplanned admission to intensive care unit. Secondary outcomes included mortality, length of stay, high dependency length of stay, comfort levels, breathing exertion levels (as measured by Borg Scale), oxygen saturation, respiratory rate, heart rate, chest X-ray and arterial blood gas parameters.

Results 220 patients (average age 60 years and average of four rib fractures each) were randomized to HFNP (n=113) and VM (n=107). There was no statistically significant difference in the primary outcome comparing HFNP and VM (6.2% vs. 6.5%, p=1.0). There were also no statistically significant differences in the secondary outcomes except for PaCO2 (43.6 vs. 45.5, p=0.039)

Conclusion HFNP oxygen supplementation does not appear to be more effective than VM oxygen supplementation in patients with rib fractures.

  • oxygen inhalation therapy
  • rib fractures
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000460

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    Footnotes

    • Contributors All authors contributed to the research project and article writing. JMH: conception of project, submission of ethics and governance approval, data analysis, article writing, review of submission. PTC: conception of project, submission of ethics and governance approval, article writing, review of article. LEC: concept of research project, submission of ethics and governance approval, review of data, article writing, review of article. MW: conception of research project, submission of ethics and governance approval, data collection, article writing, submission of research project for publishing.

    • Funding Funding for publication was provided by the Westmead Trauma Research Trust Fund.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Western Sydney Human Research Ethics Committee (AU RED HREC/15/WMEAD/509).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Database securely stored and is available on request.