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At least 19 recordsLinked to original sources

PubMed1988

Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion.

We reviewed 144 consecutive patients with flail chest and/or pulmonary contusion between 1979 and 1984. The purpose was to analyze the factors adversely affecting morbidity and mortality. There were 97 males and 47 females, with an average age of 40 years +/- 18 S.D. (range, 2-83). Seventy-five per cent of the injuries were caused by motor vehicle accidents, with the remainder due to falls (17%), cardiopulmonary resuscitation (4%), altercations (2%), or falling objects (2%). The Injury Severity Score (ISS) averaged 32 +/- 14 S.D. in all survivors versus 60 +/- 14 S.D. in those who died. Eighty-three patients (58%) required mechanical ventilation. Thirty-six patients died (25%). Isolated pulmonary contusion or flail chest had a mortality of 16% each. However, the mortality more than doubled when there was a combined pulmonary contusion and flail chest (42%). More than half of all deaths were directly attributed to central nervous system injuries with another third due to massive hemorrhage. Factors that were associated with a higher morbidity and mortality included severe associated thoracic injuries, a high ISS, the presence of shock, falls from heights, and the combination of pulmonary contusion and flail chest.

Adolescent↗

PubMed1977

The treatment of flail chest injury.

Flail chest injuries are traditionally managed by long-term artificial ventilation, which in itself is hazardous and expensive. A more conservative therapeutic regime is described, and the results of this regime are compared with those following the previous traditional regime used in the Respiratory Unit, Royal Brisbane Hospital. The place of artificial ventilation in relation to spontaneous ventilation is redefined in the context of this new regime.

Humans↗

PubMed1989

Chest wall distortion in patients with flail chest.

Ventilators can impose resistive and elastic loads during subject-initiated and spontaneous breaths. Such loads might worsen the chest wall distortion that is characteristic of patients with flail chest. We have tested this expectation in nine patients with flail chest and four normal subjects. All subjects breathed for 3 to 5 min on each of the following modes: assist control, intermittent mandatory ventilation (IMV), continuous positive airway pressure 5 to 10 cm H2O by demand valve and by a high flow system (CPAP-HF), and spontaneously (T-piece). Pressure at the airway opening was evaluated as a measure of ventilator loading, and magnetometric displacements of the major chest wall dimensions were evaluated to assess chest wall distortion. In contrast to the normal volunteers, patients with flail chest displayed chest wall distortion during active inspirations. The patterns of distortion were variable among patients. The degree of distortion varied among ventilator modes; generally, there was a greater degree of chest wall distortion in breaths with greater loading. For example, distortion was greater during the spontaneous breaths taken on the IMV-mode than during spontaneous breaths taken on the T-piece. The CPAP-HF mode resulted in the least distortion, reversing chest wall distortion in five patients, improving it in two, and not changing the distortion in the remaining two. The improvements may be related to positive pleural pressures and to the minimal ventilator-imposed load of the high gas flow system. The distortion imposed by ventilators increases the work of breathing in these patients and may thus contribute to difficulty in weaning.

Aged↗

PubMed1986

Unilateral chest wall paradoxical motion mimicking a flail chest in a patient with hemilateral C7 spinal injury.

After a lower hemi-cervical spinal cord injury, a patient presented with a left hemiplegia and on the same side a unilateral chest wall paradoxical motion mimicking a flail chest. X-rays demonstrated a left hemilateral C6 injury but no rib fractures. We demonstrated that the paradoxical motion was due to the action of the diaphragm acting on the rib cage with intercostal respiratory paralysis on the side of hemiplegia.

Diagnosis, Differential↗

PubMedDate not supplied

Flail chest as a complication of cardiopulmonary resuscitation.

Records of all patients who developed flail chest after cardiopulmonary resuscitation at Rochester Methodist Hospital between January, 1966 and March 1976 were reviewed. Also, for comparison, records of patients with flail chest resulting from motor vehicle accidents and those of a matched group of patients who underwent cardiopulmonary resuscitation without developing flail chest were reviewed. The incidence of flail chest after cardiopulmonary resuscitation was about 5.6 per 100 survivors. The groups who did and did not have flail chest after cardiopulmonary resuscitation were alike in age and in frequency and duration of the resuscitation. Stabilization of the flail chest required mechanical ventilation for 1 to 24 days (mean, 10.7). Flail chest did not significantly lengthen the hospitalization of patients who survived after cardiopulmonary resuscitation. The occurrence of flail chest after cardiopulmonary resuscitation did not seem to increase the mortality rate.

Aged↗

PubMed1992

Modern concepts in the management of flail chest.

Seven patients with varying degrees of paradoxical chest wall movement (flail chest) were managed conservatively at the University of Port Harcourt Teaching Hospital with frusemide, methylprednisolone, non administration of crystalloid fluids and limitation of fluid intake. Patients showed considerable improvement within the first 24-48 hours which was sustained throughout the period of management. All seven survived and showed no signs of respiratory distress in the resting state or while performing simple exercise. One patient however had slight to moderate chestwall deformity.

Adult↗

PubMed1990

[Clinical results of selective treatment for flail chest].

A better understanding in pathophysiology of flail chest has brought an evolution to the principles of it's management. The methods of stabilization changed from surgical to pneumatic measures and now, a concept of conservative treatment is recognized. Adhering to our protocol for flail chest, which essentially limits mechanical ventilation, we have prospectively treated 36 patients since 1981. The patient were divided into two groups according to their need for mechanical ventilation. There were 16 patients (44.4%) in a group treated in conservative manner and with no mechanical ventilation (Group A). There were 20 patients (55.6%) in a group treated by mechanical ventilation (Group B). Group A had 6.2% incidence of pneumonia, 3.6 days average stay in ICU and mortality rate of 0%. Group B had 75% pneumonia, 22.5 days average in ICU and 15% mortality. Group B patients required respiratory support for 14 days average, which was not reduced by surgical stabilization. Restrictive pulmonary disturbance in group A was milder than that of group B, and this again was not affected by surgical stabilization. We conclude that 40% of flail chest are controllable without mechanical ventilation and that the result of this conservative therapy is superior to any other treatments.

Adult↗

PubMed1975

Management of flail chest without mechanical ventilation.

The pathophysiology of flail chest is usually described only on the basis of paradoxical respiration, ignoring underlying pulmonary contusion. Two groups of comparable patients were treated either with early tracheal intubation and mechanical ventilation (Group 1), or with fluid restriction, diuretics, methylpredinisolone, albumin, vigorous pulmonary toilet, and intercostal nerve blocks, ignoring the paradox and treating only the underlying lung (Group 2). When tracheostomy and mechanical ventilation were not used the mortality rate went from 21% to O(p = 0.01), the complication rate from 100% to 20% (p = 0.005), and the average hospitalization from 31.3 to 9.3 days (p = 0.005). We conclude that most patients with flail chest do not need internal pneumatic stabilization if the underlying lung is treated appropriately and that tracheostomy and prolonged mechanical ventilation with a volume respirator, as practiced in most respiratory care centers, is usually a triumph of technique over judgment.

Adolescent↗

PubMed1990

Delayed diagnosis of flail chest.

A retrospective review of 99 consecutive patients with flail chest after trauma was conducted to determine the incidence and significance of delayed presentation. Patients ranged in age from 7 to 88 yr (mean 50.3). Hospitalization ranged from 1 to 129 days (mean 23). Mean Injury Severity Score was 30. Sixty (61%) patients were managed with mechanical ventilation. Pulmonary complications developed in 48 (48%) patients and 14 (14%) patients died. The flail chest injury was documented on initial examination of 77 (78%) patients. Delayed presentation occurred in 22 (22%) patients from 1 to 10 days after injury. Reasons for delayed diagnosis included intubation and mechanical ventilation before complete physical examination, development of pulmonary complications with the attendant increased work of breathing, and physician error. The time of presentation was not associated with patient age, sex, severity of injury, need for mechanical ventilation, duration of ventilation, incidence of pulmonary morbidity, or mortality.

Adolescent↗

PubMed1979

The unchanged mortality of flail chest injuries.

Six hundred eighty-five patients with major blunt thoracic injuries from 1968 through 1977 were retrospectively studied. This series was compared to a similar series from 1959 through 1964. Between 1964 and 1968 a vastly improved hospital was built, laboratory support improved, pressure-controlled ventilators replaced by volume-controlled ventilators and the trauma service was reorganized. The treatment regimen for flail chest injuries during the last decade evolved from the previous early tracheostomy and prolonged ventilator support to an avoidance of tracheostomy and brief ventilator support. The overall mortality in the present series was 20% compared to 35% for the 1959--1964 series; however, improved mortality occurred only among patients with hemothorax who had one or more major concomitant extrathoracic injuries. The mortality for flail chest injuries did not improve (29.5 vs 35.0%). Mortality was unchanged for isolated flail chest injuries, isolated pneumothorax, isolated hemothorax, and for flail chest injuries, and pneumothorax in patients with concomitant major extrathoracic injuries. In both series deaths from isolated thoracic injuries were rare. It is evident that the continued high mortality for blunt thoracic trauma principally relates to concomitant extrathoracic injuries and that recent treatment innovations have not reduced the mortality of flail chest injuries.

Adolescent↗

PubMed1978

Flail chest syndrome and pulmonary contusion.

Controlled mechanical ventilation has been the mainstay of treatment in the flail chest syndrome for more than 20 years, retrospective studies have recently suggested that the technique is unnecessary, and they infer that spontaneous ventilation or intermittent mandatory ventilation are equally effective. The common theme of these investigations is that mechanical ventilation is required only to relieve hypoxemia associated with the underlying contusion. In two cases of flail chest, spontaneous respiratory efforts resulted in complete disruption of the fracture sites and thus prolonged the duration of mechanical ventilation that was required. In severe cases of flail chest syndrome, there is still a need for controlled mechanical ventilation to splint the rib fractures in a position which facilitates union of the fragments.

Adult↗

PubMed1990

Open fixation of flail chest after blunt trauma.

Progressive left chest volume loss developed in a patient with severe flail chest despite reasonable oxygenation without intubation. Because of this chest volume loss, pain, and shortness of breath, she underwent open chest wall repair using multiple metallic struts. Rapid recovery ensued, despite a perforated duodenal ulcer on postoperative day 1. Benefits of open fixation of severe flail chest are clearly demonstrated and should be considered instead of prolonged ventilation or supportive care alone for select patients.

Aged↗

PubMed1990

Conservative management of flail chest.

A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.

Adolescent↗

PubMed1977

[Treatment of flail chest from the general surgical view. Experience with 20 cases].

Flail chest is a serious complication of multiple fractures of the ribs that needs immediate management in order to avoid its disastrous respiratory and circulatory consequences. The authors present their experience with 20 cases of flail chest injury and discuss especially some practical aspects of its treatment. Skeletal traction was used frequently to stabilize the chest wall, while intermittent positive pressure respiration was reserved only for patients with uncompensated respiratory disturbances. The authors urge that a well-organized surgical unit should be able to provide appropriate management in such cases, since most of these patients have multiple injuries that need general surgical together with more specialized treatment.

Adolescent↗

PubMed1992

External stabilization of flail chest using continuous negative extrathoracic pressure.

On rare occasions after total sternectomy, patients develop persistent flail chest deformities requiring long-term mechanical respiratory assistance. We report the use of a temporary external chest shell to deliver constant negative extrathoracic pressure (CNEP) to a long-term ventilated patient with flail chest. The patient's anterior thoracic cage stabilized, and significant improvement in pulmonary function was observed. With these data in hand, an operation was done to permanently stabilize the anterior chest wall by bone grafting.

Aged↗

PubMed1979

Early and late results of controlled ventilation in flail chest.

From 1967 through 1974, a consecutive series of 35 patients with flail chest were treated with intermittent positive-pressure breathing (IPPB). The controlled ventilation contributed to stabilization of the thoracic cage in a favorable position for healing of the fractures. Surgical stabilization of the chest was not attempted in any of the cases. During treatment with IPPB, one patient died from profuse bleeding due to a generalized coagulation disorder, but the remaining 34 were discharged in a satisfactory respiratory condition. A late follow-up study of the pulmonary function one to eight years after the trauma included x-ray films of the trachea and lungs, kymographic studies of the diaphragm, spirometric and radiospirometric testing, and arterial blood gas levels. Eighteen patients were examined. Spirometric testing revealed astonishingly little impairment of the total pulmonary function. The radiospirometric studies with 133xenon showed a significant reduction of the regional perfusion only in five patients (2 to 4.5 pulmonary segments). Kymographic study of the diaphragm gave no further information and was less selective compared with the other tests of pulmonary function. Owing to the encouraging early and late results in this study, early treatment with IPPB is considered to be the method of choice in flail chest with paradoxic respiratory movements.

Adolescent↗

PubMed1976

The management of flail chest. A comparison of ventilatory and nonventilatory treatment.

Retrospective analysis of forty-two consecutive patients with flail chest injuries admitted to the Trauma Research Unit of the Naval Regional Medical Center, San Deigo from June 1972 to July 1975 compared ventilatory and nonventilatory management. The actual need for ventilatory support in these patients was determined by analyzing their records for evidence of significant pulmonary dysfunction. This allowed division of patients into three groups: "appropriately" ventilated; "inappropriately" ventilated; and nonventilated. Admission PO2 in the "appropriately" ventilated patients was significantly lower than in the other two groups because the former were admitted with respiratory distress and hypoxemia. Significantly more complications occurred in the ventilated groups than in the nonventilated. Treatment-associated complications were more frequent in the ventilated groups. Because of these findings, we belive that mechanical ventilation should be used in the treatment of flail chest injuries only for significant pulmonary dysfunction and not for the purpose of stabilizing the chest wall. If respiratory support is required, it should be discontinued when normal gas exchange has been restored.

Adolescent↗

PubMed1978

[Surgical treatment of the flail chest (author's transl)].

Six patients with traumatic flail chest underwent surgical stabilization using a procedure introduced by Brunner, Hoffmeister and Koncz (2). Compared with internal stabilization by intermittend positive pressure respiration (IPPR), there are some advantages: Time of artificial respiration is shortened, early mobilization is possible, nursing is easier. The procedure is simple to do and is indicated in those patients, in whom longterm artificial respiration is not necessary for other reasons.

Adult↗