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Re: Flailing around over a definition!

Dear Editor,

With reference to Gundoz et al. and their article on CPAP vs. IPPV in the management of flail chest injuries I would just like to clarify a few points.

Firstly in their definition of what actually constitutes a flail chest, the presence of five or more rib fractures in a row was part of the inclusion criteria. There is no doubt that five consecutive rib fractures most definitely points to a severe thoracic injury, but strictly speaking, does it actually constitute a flail segment? I would like the author to clarify how many in the study actually had flail segments and what their outcome was.

The second query I have regards the use of ICU mortality as a primary end point. Surely length of hospital stay would be a much more useful marker in terms of knowing how well the subjects faired long term?

Overall, I found the article extremely useful and it certainly has generated debate in the ICU I work in about how best to manage these injuries.