Respiratory Function Monitoring of Mechanical Ventilation in Patients With Chest Blunt Injury

Trauma is the leading cause of death among middle-aged and young people in China, with over 25% of patients dying from chest trauma. The incidence of pulmonary contusion in severe chest trauma is over 70%, and it is an important cause of respiratory failure and even death in patients. The occurrence of pulmonary contusion and respiratory failure in patients with chest contusion is a dynamic process, and Regional inhomogeneities of the damaged lung should be taken into consideration to develop improved ventilation strategies. Currently, there is no ideal monitoring method to evaluate the severity of injury, and guide the ventilation strategies. Electrical impedance tomography (EIT) is a non-invasive, radiation-free imaging technique. It measures regional lung ventilation and aeration distribution by means of changes in electrical potentials at the skin surface of the chest wall during breathing cycles, which has been proven to have good practicality in patients with non-invasive ARDS and pulmonary embolism. In this study, we aim to characterize the physiologic effects of positive end expiratory pressure (PEEP) on key mechanisms of regional lung protection, namely: recruitment, reduced atelectrauma, and improved ventilation-perfusion matching, by CT scan and EIT

Inclusion criteria

• Patients with severe chest contusion admitted to the intensive care unit (ICU);
• Abbreviated Injury Scale (AIS) ≥ 3 and/or Blunt Pulmonary Contusion 18 score (BPC18) ≥ 3;
• Age range from 18 to 90 years old;
• Mechanical ventilation;
• Stay in the ICU for less than 12 hours.

Exclusion criteria

• Perinatal women;
• Expected to be mechanically ventilated for less than 48 h;
• Expected duration of stay in the ICU is less than 24 hours;
• There are contraindications for the use of EIT (pacemaker implantation, local skin wounds after chest surgery, etc.);
• Accept extracorporeal membrane oxygenator;
• Mechanical ventilation>7 days;
• Confirmed ventilator-associated pneumonia;
• Pneumothorax without drainage or presence of subcutaneous emphysema.