Critically Crushed Chests. A New Method of Treatment With Continuous Mechanical Hyperventilation to Produce Alkalotic Apnea and Internal Pneumatic Stabilization

Patient-Ventilator Interaction: The Last 40 Years

“…[13][14][15][16] In fact, the synchrony was perfect, because the patients were rendered apneic. The landmark paper by Avery and co-workers, "Critically crushed chests: a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization," concentrated on treatment of the chest wall.…”

“…The landmark paper by Avery and co-workers, "Critically crushed chests: a new method of treatment with continuous mechanical hyperventilation to produce alkalotic apnea and internal pneumatic stabilization," concentrated on treatment of the chest wall. 13 Pulmonary contusion was not recognized as an important pathologic feature.…”

“…[13][14][15][16] The instability of the chest wall was thought to result in ineffective breathing and the movement of gases between the lung segments, preventing adequate alveolar ventilation. Windsor and Dwyer described the treatment of a number of crushed chest injuries, and their own words here detail the therapy.…”

Rib stabilization: lessons learned

“…Initial approaches involving skeletal traction with fracture segments suspended using towel clips and pins clearly ignored the pulmonary parenchymal dysfunction that was an equally important factor [2,3]. In the 1950s and 1960s, the concept of ''internal pneumatic stabilization'' [4] involving tracheostomy and positive pressure ventilation supported both problems, but selective attention was no longer paid to the individual importance of parenchymal versus mechanical factors, and overall results remained poor [5]. Most recently, the pendulum of care has switched to almost completely discounting the mechanical effects and attributing most of the dysfunction to parenchymal injury and the underlying pulmonary contusion which often accompanies these injuries [6].…”

Intermittent positive pressure ventilation for the crushed chest: an epic in intensive care

“…ªWe were amazed to observe how rapidly the numerous rib fragments moved back into placeº [1]. So successful was the technique that it became possible to remove the external traction completely.…”