Original Scientific ArticlesOperative chest wall stabilization in flail chest—outcomes of patients with or without pulmonary contusion
Section snippets
Methods
The hospital records of 405 consecutive patients with multiple trauma (Injury Severity Score [ISS] > 17) including patients with isolated severe blunt chest trauma (Abbreviated Injury Scale [AIS]-thorax ≥ 3) primarily admitted to the Department of Trauma Surgery, University Hospital Essen, Germany between 1988 and 1994 were reviewed (ISS 25.5 ± 10.0). Two hundred and ninety-five (out of 405) of these patients (ISS 26.7 ± 10.0) sustained severe blunt chest trauma AIS thorax 3.4 ± 0.6). Forty-two
Extent of injury
Group 1: The mean ISS was 31.0 ± 7.0 (range, 24–41). Only one patient sustained isolated blunt chest trauma; all other patients had multiple injuries. The major diagnosis was blunt chest trauma demonstrated by a mean AIS-thorax of 4.1 ± 0.3 (range, 4–5). Associated injuries were injuries of the head (AIS 1.7 ± 1.3 [range, 0–3]), of the abdomen (AIS 1.7 ± 1.6 [range, 0–4]), of the extremities (AIS 1.6 ± 2.6 [range, 0–4]), and of the face (AIS 0.9 ± 1.6 [range, 0–4]). The most common associated
Discussion
Despite improved methods in intensive trauma care and advanced techniques in mechanical ventilation, mortality of patients with flail chest remains quite high.4, 13 To avoid the well known complications of longterm ventilation, internal pneumatic stabilization should be avoided. Local pain relief (epidural analgesia), chest physiotherapy (mask continuous positive airway pressure [CPAP]) and removal of pulmonary secretions are essential in management of flail chest without ventilatory support.
Conclusions
- 1.
Flail chest without pulmonary contusion necessitating ventilatory assistance despite sufficient analgesia and mask-CPAP from persisting hypoxemia seems to be a rational indication for operative chest wall stabilization in patients without severe head injury. Early operative chest wall stabilization within 48 hours permits extubation after a mean ventilator time of 6.5 days.
- 2.
There is a role for selective operative chest wall stabilization in patients with pulmonary contusion, and it should only
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