Skip to main content
NCBI home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1983 Nov 15;129(10):1104–1107.

Management of flail chest.

H A Miller, G A Taylor, A W Harrison, R Maggisano, S Hanna, J L de Lacy, H Shulman
PMCID: PMC1875489  PMID: 6627170

Abstract

This paper compares the management of two groups of patients with flail chest. The 25 patients in group 1 had a flail chest without other significant injuries or shock, whereas the 57 in group 2 had a flail chest with multiple injuries, shock or both. The group 1 patients were treated with repeated multiple intercostal nerve blocks or high segmental epidural analgesia, oxygen, intensive chest physiotherapy, fluid restriction, furosemide diuretics, methylprednisolone sodium succinate and colloid infusion in an intensive care unit. In addition to these measures, the group 2 patients underwent endotracheal intubation and assisted mechanical ventilation with a volume respirator that provided continuous positive airway pressure and positive end-expiratory pressure. Of the 57 group 2 patients 36 required prolonged ventilation, eventually through a tracheostomy, because of severe head injury, pneumonia, severe facial injury, quadriplegia, pre-existing lung disease or severe sepsis. However, tracheostomy was avoided in the other 21 patients in group 2. There were no deaths in group 1, but 8 (14%) of the patients in group 2 died. These results show that avoidance of tracheostomy and ventilation in selected patients with flail chest is consistent with a low morbidity and mortality.

Full text

PDF
1104

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. Alfano G. S., Hale H. W., Jr Pulmonary contusion. J Trauma. 1965 Sep;5(5):647–658. doi: 10.1097/00005373-196509000-00009. [DOI] [PubMed] [Google Scholar]
  3. Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
  4. Brennan J. A., Field J. M., Liedtke A. J. Reversible heart block following nonpenetrating chest trauma. J Trauma. 1979 Oct;19(10):784–788. doi: 10.1097/00005373-197910000-00013. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. 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]
  7. Duff J. H., Goldstein M., McLean A. P., Agrawal S. N., Munro D. D., Gutelius J. R. Flail chest: a clinical review and physiological study. J Trauma. 1968 Jan;8(1):63–74. [PubMed] [Google Scholar]
  8. Fulton R. L., Peter E. T. The progressive nature of pulmonary contusion. Surgery. 1970 Mar;67(3):499–506. [PubMed] [Google Scholar]
  9. GAENSLER E. A., STRIEDER J. W. Pulmonary function before and after extrapleural pneumothorax; a comparison with other forms of collapse and resection. J Thorac Surg. 1950 Nov;20(5):774–797. [PubMed] [Google Scholar]
  10. Garzon A. A., Gourin A., Seltzer B., Chiu C. J., Karlson K. E. Severe blunt chest trauma. Studies of pulmonary mechanics and blood gases. Ann Thorac Surg. 1966 Sep;2(5):629–639. doi: 10.1016/s0003-4975(10)66632-5. [DOI] [PubMed] [Google Scholar]
  11. Liedtke A. J., DeMuth W. E., Jr Nonpenetrating cardiac injuries: a collective review. Am Heart J. 1973 Nov;86(5):687–697. doi: 10.1016/0002-8703(73)90349-9. [DOI] [PubMed] [Google Scholar]
  12. Liedtke A. J., Gault J. H., Demuth W. E. Electrocardiographic and hemodynamic changes following nonpenetrating chest trauma in the experimental animal. Am J Physiol. 1974 Feb;226(2):377–382. doi: 10.1152/ajplegacy.1974.226.2.377. [DOI] [PubMed] [Google Scholar]
  13. MALONEY J. V., Jr, SCHMUTZER K. J., RASCHKE E. Paradoxical respiration and "pendelluft". J Thorac Cardiovasc Surg. 1961 Mar;41:291–298. [PubMed] [Google Scholar]
  14. McIntyre R. W., Laws A. K., Ramachandran P. R. Positive expiratory pressure plateau: improved gas exchange during mechanical ventilation. Can Anaesth Soc J. 1969 Nov;16(6):477–486. doi: 10.1007/BF03004541. [DOI] [PubMed] [Google Scholar]
  15. RANSDELL H. T., Jr TREATMENT OF FLAIL CHEST INJURIES WITH A PISTON RESPIRATOR. J Trauma. 1965 May;5:412–420. doi: 10.1097/00005373-196505000-00013. [DOI] [PubMed] [Google Scholar]
  16. REID J. M., BAIRD W. L. CRUSHED CHEST INJURY: SOME PHYSIOLOGICAL DISTURBANCES AND THEIR CORRECTION. Br Med J. 1965 Apr 24;1(5442):1105–1109. doi: 10.1136/bmj.1.5442.1105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Scott M. L., Arens J. F., Ochsner J. L. Fractured sternum with flail chest and posttraumatic pulmonary insufficiency syndrome. Report of 4 patients. Ann Thorac Surg. 1973 Apr;15(4):386–393. doi: 10.1016/s0003-4975(10)65320-9. [DOI] [PubMed] [Google Scholar]
  18. 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]
  19. Symbas P. N. Cardiac trauma. Am Heart J. 1976 Sep;92(3):387–396. doi: 10.1016/s0002-8703(76)80120-2. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. 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]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES