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. 1982 Oct;196(4):481–487. doi: 10.1097/00000658-198210000-00012

Selective management of flail chest and pulmonary contusion.

J D Richardson, L Adams, L M Flint
PMCID: PMC1352715  PMID: 7125734

Abstract

Four hundred and twenty-seven patients with severe blunt chest trauma were treated resulting in (1) flail chest, (2) pulmonary contusions, (3) pneumothorax, (4) hemothorax, or (5) multiple rib fracture. The need for endotracheal intubation and mechanical ventilation was determined selectively by standard clinical criteria. Avoidance of fluid overload and vigorous pulmonary toilet was attempted in all patients. Three hundred and twenty-eight patients were treated by nonintubation; 318 patients (96.6%) had a successful outcome, while ten required intubation. Only one patient died. The 99 patients who required intubation and mechanical ventilation had a high mortality because of associated shock and head injury; however, the total mortality for the entire group of patients was 6.5%, with only 1.4% mortality caused by pulmonary injury. The incidence of pneumonia was high (51%), but there was only a 4% incidence of tracheostomy complications. Flail chest and pulmonary contusion without flail chest occurred in 95 and 135 patients, respectively. Half of the flail chest patients were intubated, but 69.5% were intubated less than three days. Twenty per cent of the patients with pulmonary contusion required mechanical ventilation, usually for less than three days. This study demonstrates that patients with severe blunt chest trauma can be managed safely by selective intubation and mechanical, ventilation and that the incidence of complications associated with controlled mechanical ventilation can be greatly reduced.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AVERY E. E., BENSON D. W., MORCH E. T. Critically crushed chests; a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization. J Thorac Surg. 1956 Sep;32(3):291–311. [PubMed] [Google Scholar]
  2. Craven K. D., Oppenheimer L., Wood L. D. Effects of contusion and flail chest on pulmonary perfusion and oxygen exchange. J Appl Physiol Respir Environ Exerc Physiol. 1979 Oct;47(4):729–737. doi: 10.1152/jappl.1979.47.4.729. [DOI] [PubMed] [Google Scholar]
  3. Cullen P., Modell J. H., Kirby R. R., Klein E. F., Jr, Long W. Treatment of flail chest. Use of intermittent mandatory ventilation and positive end-expiratory pressure. Arch Surg. 1975 Sep;110(9):1099–1103. doi: 10.1001/archsurg.1975.01360150043008. [DOI] [PubMed] [Google Scholar]
  4. Dontigny L. Management of critical emergencies in chest trauma. Can J Surg. 1978 Nov;21(6):516–518. [PubMed] [Google Scholar]
  5. Dougall A. M., Paul M. E., Finely R. J., Holliday R. L., Coles J. C., Duff J. H. Chest trauma--current morbidity and mortality. J Trauma. 1977 Jul;17(7):547–553. [PubMed] [Google Scholar]
  6. Lewis F. L., Jr, Thomas A. N., Schlobohm R. M. Control of respiratory therapy in flail chest. Ann Thorac Surg. 1975 Aug;20(2):170–176. doi: 10.1016/s0003-4975(10)63872-6. [DOI] [PubMed] [Google Scholar]
  7. Lucas C., Tintinalli J. E. Flail chest. JACEP. 1979 Sep;8(9):380–383. doi: 10.1016/s0361-1124(79)80265-8. [DOI] [PubMed] [Google Scholar]
  8. Mulder D. S. Symposium on trauma. 2. Chest trauma: current concepts. Can J Surg. 1980 Jul;23(4):340–342. [PubMed] [Google Scholar]
  9. Parham A. M., Yarbrough D. R., 3rd, Redding J. S. Flail chest syndrome and pulmonary contusion. Arch Surg. 1978 Jul;113(7):900–903. doi: 10.1001/archsurg.1978.01370190122027. [DOI] [PubMed] [Google Scholar]
  10. Relihan M., Litwin M. S. Morbidity and mortality associated with flail chest injury: a review of 85 cases. J Trauma. 1973 Aug;13(8):663–671. doi: 10.1097/00005373-197308000-00001. [DOI] [PubMed] [Google Scholar]
  11. Richardson J. D., Franz J. L., Grover F. L., Trinkle J. K. Pulmonary contusion and hemorrhage--crystalloid versus colloid replacement. J Surg Res. 1974 Apr;16(4):330–336. doi: 10.1016/0022-4804(74)90051-1. [DOI] [PubMed] [Google Scholar]
  12. Sankaran S., Wilson R. F. Factors affecting prognosis in patients with flail chest. J Thorac Cardiovasc Surg. 1970 Sep;60(3):402–410. [PubMed] [Google Scholar]
  13. Schaal M. A., Fischer R. P., Perry J. F., Jr The unchanged mortality of flail chest injuries. J Trauma. 1979 Jul;19(7):492–496. [PubMed] [Google Scholar]
  14. Shackford S. R., Smith D. E., Zarins C. K., Rice C. L., Virgilio R. W. The management of flail chest. A comparison of ventilatory and nonventilatory treatment. Am J Surg. 1976 Dec;132(6):759–762. doi: 10.1016/0002-9610(76)90453-0. [DOI] [PubMed] [Google Scholar]
  15. Shackford S. R., Virgilio R. W., Peters R. M. Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg. 1981 Feb;81(2):194–201. [PubMed] [Google Scholar]
  16. Sladen A., Aldredge C. F., Albarran R. PEEP vs. ZEEP in the treatment of flail chest injuries. Crit Care Med. 1973 Jul-Aug;1(4):187–191. doi: 10.1097/00003246-197307000-00002. [DOI] [PubMed] [Google Scholar]
  17. Trinkle J. K., Furman R. W., Hinshaw M. A., Bryant L. R., Griffen W. O. Pulmonary contusion. Pathogenesis and effect of various resuscitative measures. Ann Thorac Surg. 1973 Dec;16(6):568–573. doi: 10.1016/s0003-4975(10)65037-0. [DOI] [PubMed] [Google Scholar]
  18. Trinkle J. K., Richardson J. D., Franz J. L., Grover F. L., Arom K. V., Holmstrom F. M. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975 Apr;19(4):355–363. doi: 10.1016/s0003-4975(10)64034-9. [DOI] [PubMed] [Google Scholar]

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