In our previous study, the investigators analyzed more than 30,000 cases from the National Trauma Center Database and found that 66.4% of patients with severe blunt chest trauma had concurrent rib fractures, 55.87% had multiple fractures (≥4 ribs), and 37.4% had combined pulmonary contusion. In a further prospective observational cohort study evaluating the efficacy of EIT-guided OLE in such patients, results demonstrated that this protocol improved the ventilation-perfusion ratio and oxygenation index and shortened total mechanical ventilation duration. Based on literature review and preliminary findings, the investigators propose the following hypothesis: the application of EIT-noninvasively monitored OLE airway clearance in patients with severe blunt chest trauma can improve the ventilation-perfusion ratio, shorten mechanical ventilation time, reduce the incidence of complications such as pulmonary infection and mortality, and decrease medical resource consumption.
This study will verify this hypothesis through a prospective randomized controlled trial and further refine the specific implementation protocol of OLE to enhance its scientific validity and clinical applicability.
Severe blunt chest trauma, defined as injury caused by blunt force such as chest impact or compression, with an Abbreviated Injury Scale (AIS) score of the chest ≥ 3
Age 18 to 70 years
Time from injury to enrollment < 48 hours
Receiving invasive mechanical ventilation, with duration of mechanical ventilation < 24 hours
Combined penetrating chest trauma
Perinatal women
Inability of the patient to cooperate with examinations and treatment
Contraindications to EIT monitoring, including implanted cardiac pacemaker, unhealed local skin wound after thoracic surgery, extensive subcutaneous emphysema of the chest, etc
the cohort will be selected from a tertiary hospital
Cohort
Prospective
Different therapeutic interventions
Other interventionEligible patients who met the inclusion and exclusion criteria were randomly assigned to the intervention group and the control group at a 1:1 ratio. Intervention group: received OLE airway clearance therapy guided by noninvasive monitoring technology. Control group: received conventional airway clearance therapy, including routine suction via flexible bronchoscopy, etc.
Cumulative total duration of the first mechanical ventilation (hours)
Degree of improvement in ventilation/perfusion (V/Q) matching
Incidence of ventilator-associated pneumonia (VAP) during ICU stay
Length of ICU stay
Length of total hospital stay
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