PT  - JOURNAL ARTICLE
AU  - H. A. Miller
AU  - G. A. Taylor
AU  - A. W. Harrison
AU  - R. Maggisano
AU  - S. Hanna
AU  - J. L. de Lacy
AU  - H. Shulman
TI  - Management of flail chest
DP  - 1983 Nov 15
TA  - Canadian Medical Association Journal
PG  - 1104--1107
VI  - 129
IP  - 10
4099  - http://www.cmaj.ca/content/129/10/1104.short
4100  - http://www.cmaj.ca/content/129/10/1104.full
SO  - CMAJ1983 Nov 15; 129
AB  - 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.