Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review

INTRODUCTION: This systematic review looks at the use of noninvasive ventilation (NIV), inclusive of noninvasive positive pressure ventilation (NPPV) and continuous positive pressure ventilation (CPAP), in patients with chest trauma to determine its safety and clinical efficacy in patients with blunt chest trauma who are at high risk of acute lung injury (ALI) and respiratory failure. METHODS: We searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Pairs of reviewers abstracted relevant clinical data and assessed the methodological quality of randomized controlled trials (RCTs) using the Cochrane domain and observational studies using the Newcastle-Ottawa Scale. RESULTS: Nine studies were included (three RCTs, two retrospective cohort studies and four observational studies without a comparison group). There was significant heterogeneity among the included studies regarding the severity of injuries, degree of hypoxemia and timing of enrollment. One RCT of moderate quality assessed the use of NPPV early in the disease process before the development of respiratory distress. All others evaluated the use of NPPV and CPAP in patients with blunt chest trauma after the development of respiratory distress. Overall, up to 18% of patients enrolled in the NIV group needed intubation. The duration of NIV use was highly variable, but NIV use itself was not associated with significant morbidity or mortality. Four low-quality observational studies compared NIV to invasive mechanical ventilation in patients with respiratory distress and showed decreased ICU stay (5.3 to 16 days vs 9.5 to 15 days), complications (0% to 18% vs 38% to 49%) and mortality (0% to 9% vs 6% to 50%) in the NIV group. CONCLUSIONS: Early use of NIV in appropriately identified patients with chest trauma and without respiratory distress may prevent intubation and decrease complications and ICU length of stay. Use of NIV to prevent intubation in patients with chest trauma who have ALI associated with respiratory distress remains controversial because of the lack of good-quality data

Armed Forces, Cyberspace, and Global Images

This study centers on the relation between militaries, violence, and publicly available digital images. Military websites can be characterized as forms of representation of national institutions comparable to the sites of any large organization. However, the way these websites publicly frame and explain the military’s use of organized violence has not been investigated. Accordingly, this study examines how contemporary militaries manage their public and online relation to their core expertise, organized violence. The analysis is based on a longitudinal analysis of the Israeli Defense Force’s (IDF) official websites (2007–2015) and interviews with key webmasters. The integration of the Internet and new media into the IDF’s official websites highlights its deliberate move into the cybernetic realm to manage, order, manipulate, and handle its public images and representations as a legitimate social institution charged with using violence in the defense of the country. </jats:p