I. Condon, P. Papadakos
[Applied Cardiopulmonary Pathophysiology 15: 51-54, 2011]
Introduction: Non invasive respiratory support has been used in a wide variety of settings. This case report illustrates the benefit of such support in a complex multi-trauma patient.
Case presentation: A 42 year-old male restrained driver was brought to the trauma bay with multiple injuries. These included: aortic transection, frontal lobe hemorrhages, bilateral pneumothoraces, multiple rib fractures, diaphragmatic rupture, C7 fracture, and pubic rami fractures. After surgical repair, the patient was transferred to the Kessler Burn Trauma ICU sedated and ventilated. Serial bronchoscopies were performed to improve aeration of his left lung over the next week. The patient was extubated on POD # 9 but required reintubation the following day due to lung collapse. A regimen of non invasive positive pressure ventilation was initiated to avoid reintubation for repeated bronchoscopies. The therapy was successful and the patient progressed to room air after one week.
Conclusion: Studies have strongly supported the use non invasive respiratory support for reducing morbidity and mortality of specific groups of patients in acute respiratory failure. In this case report it was used successfully in an acute multi-trauma patient. Non invasive respiratory support should be considered for the prevention and treatment of acute respiratory failure in even the most complex patients.
Key words: multi-trauma, non invasive respiratory support, atelectasis, diaphragmatic dysfunction
Peter J. Papadakos, M.D. FCCM FCCP
The University of Rochester Medical Center
601 Elmwood Ave
Rochester NY 14642