Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Blunt traumas are commonly secondary to motor vehicle accidents (MVAs), falls and crush or blast injuries. Notably, pain control seems a crucial endpoint in our success to deliver non-invasive ventilation to patients with chest trauma, when feasible as a pivotal component of patient care after chest trauma, along with non-invasive ventilation. In this context, dexmedetomidine could be an alternative to improve NIV tolerance that  provides sedation and analgesia with no significant respiratory depression and a reduced risk of delirium. In addition, Ketamine has several advantages compared with conventional sedatives such as preserving pharyngeal and laryngeal protective reflexes, lowering airway resistance, increasing lung compliance, and being less likely to produce respiratory depression. Therefore; this review article will briefly discusses the safety and efficacy of Dexmedetomidine versus Ketamine in non-invasive ventilation after blunt chest trauma