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PubMed2006

Successful use of non-invasive positive pressure ventilation in a complicated flail chest.

The current advanced trauma life support manual states that patients with significant hypoxia namely, SaO2 <90% on room air as a result of pulmonary contusion should be intubated and ventilated within the first hour of injury. Recently, several researchers have shown improved outcomes when patients with acute respiratory failure are managed with non-invasive positive pressure ventilation NIPPV. Trauma patients may also benefit from this therapy. We report a case of 15-year-old boy with isolated flail chest and pulmonary contusion, who was intubated in the emergency room, and was managed successfully with the NIPPV in the intensive care unit ICU despite, having had aspiration pneumonia early in the course of his stay. After initial stabilization, he failed a spontaneous breathing trial. Due to absence of contraindications to the use of NIPPV, the patient was extubated on day 7 from pressure support ventilation of 15 cmH2O and positive end expiratory pressure of 8 cmH2O to immediate NIPPV use. Three days later after a total of 50 hours of NIPPV use in the ICU the patient was successfully discharged home.

Adolescent↗

PubMed1975

Treatment of flail chest. Use of intermittent mandatory ventilation and positive end-expiratory pressure.

For the past two years we have treated patients with flail chest injuries and concomitant respiratory failure with intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP). Prior to 1972 these patients were treated with controlled mechanical ventilation (CMV) until gross flailing ceased and inspiratory force and vital capacity measurements were adequate. We retrospectively studied the charts of 37 consecutive patients to compare the length of mechanical ventilatory support of patients managed by conventional CMV with those ventilated with IMV and PEEP. The mean ventilation time of patients treated with IMV and PEEP (5.1 +/- 4.7 days) was significantly less than that of the patients treated with CMV (18.8 +/- 14.4 days) (P less than .001).

Accidents, Traffic↗

PubMed1997

[Rib fractures and flail chest in closed chest trauma--stabilizing operations and the results].

A contingent of patients presenting closed chest injuries, sustained over a 12-year period (1985-1996), are analyzed. Of the total of 6938 traumas, chest injuries amount to 3286 (47.06 per cent) of which 2842 (40.7 per cent)-closed. Of the latter 2248 (79.09 per cent) are located in the left thoracic half, 420 (14.77 per cent)-in the right thoracic half, and in 174 (6.12 per cent) it is a matter of bilateral involvement. At the point of heaviest impact, involving 5th to 9th rib segment, left side injury is recorded in 2034 cases (71.56 per cent), right side--408 (14.35 per cent), and bilateral--in 155 (5.45 per cent). There are 28 fractures of the sternum (0.85 per cent). Of the latter 14 are located in the manubrium sterni region, twelve--in the middle portion, and two in the distal part of the sternum. Over the last 5 years (1991 through 1995), of 63 casualties with flail chest 16 are with indications for stabilization osteosynthesis, and accordingly subjected to operation. A Schimelmann plate is used in 13 cases, artificial rib type "Ampar"--in three, and sternal stabilization--in one.

Bone Plates↗

PubMed1985

Rib fracture healing in experimental flail chest.

Sixteen dogs were placed under general anesthesia and flail segments of the left chest were created by transecting ribs 7,8,9, and 10 anteriorly and posteriorly. Fractures were 10 cm apart so that a 10-cm flail segment encompassing four ribs was created. In Group I, the control (N = 5), the chest wall muscles were closed without any stabilization of the fractures. Group II (N = 5) had stabilization of both anterior and posterior fracture sites by polypropylene sutures. Group III (N = 6) had stabilization of the fractures in ribs 7 and 8 with 2.5-cm bone grafts taken from the left fourth rib. Ribs 9 and 10 were stabilized by polypropylene sutures. The study established a canine model for flail chest. It also showed that strut stabilization of rib fractures with bone grafts promotes better healing than suture stabilization. It suggests that using bone grafts taken from another rib to stabilize flail segments may be unsatisfactory since the rib used as a donor showed no signs of regeneration at 30 days.

Animals↗

PubMed1950