Effect of Positive Expiratory Pressure on the Management of Chest Trauma

After acceptance to participate in the study, patients will be computerized randomized into 2 groups:

• PEP group: positive expiratory pressure breathing.
• CONTROL group: conventional CP treatment without positive pressure brething. The period between day 0 and 20 days post-trauma is considered an immediate phase of CT.

Once admitted, an initial evaluation by the doctor will be performed, and pleuro-pulmonary complications, the presence of respiratory failure, and pain control will be evaluated. The chest physiotherapist will perform a clinical and secretion assessment using the Seva test and a dynamic costal examination. The medical treatment of pain control will begin, and the treatment of CP will begin, where it will be randomized in 2 groups: 1- PEP group: positive expiratory pressure breathing with the help of a PEP bottle device. 2-CONTROL group: conventional CP treatment without positive pressure breathing will be daily FR sessions, on weekdays. Upon admission, hospital discharge and post-discharge, radiological checks (simple radiography) will be performed and forced vital capacity will be measured with forced spirometry.

Inclusion criteria

• Chest trauma with three or more rib fractures with or without hemopneumothorax
• Failure to meet any exclusion criteria

Exclusion criteria

• Non-cooperative patients for not understanding chest physiotherapy techniques.
• Presence of respiratory failure on admission: PaO2 <60mmHg i / or PaCO2> 50mmHg.
• Medical indication for mechanical ventilation or non-invasive ventilatory support.
• Presence of undrained pneumothorax.
• Complications that limit early mobility.