Flail Chest: Influence on Length of Stay and Mortality in Blunt Chest Injury

Udekwu, Pascal; Roy, Sara; McIntyre, Sarah; Farrell, Meagan T.

doi:10.1177/000313481808400940

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Data used in this study were an addition to an existing dataset for a larger retrospective observational cohort study previously approved by the Institutional Review Board at a Level 1 trauma center. 16,17 Adult patients admitted between January 1, 2014, and June 30, 2016, with a blunt chest injury were identified for further review.…”

Section: Methodsmentioning

confidence: 99%

Impact of Anticoagulant and Antiplatelet Use on Outcomes in Blunt Chest Injury

Udekwu

Roy

Stiles

et al. 2019

The American Surgeon

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The aim of this study was to evaluate the impact of prehospital antiplatelet and/or anticoagulant (APAC) use on treatment and outcomes in patients with severe blunt chest injury. Patients with three or more rib fractures and a hospital length of stay (LOS) > three days admitted from 2014 to 2015 were included. Demographics, mortality, complications, injuries, hospital and ICU LOS, use of blood products, and thoracostomy were studied. Of 383 patients, 27.4 per cent were on APAC medication. Patients on APAC were older ( P < 0.0001), had higher Glasgow Coma Score ( P < 0.0001), and had lower Injury Severity Score ( P < 0.0001) and total number of fractures ( P = 0.0013) than the non-APAC group. APAC was not a predictor of mortality with or without age adjustment. In multiple linear regressions, APAC did not predict an increased LOS. APAC patients did not demonstrate an increase in admission diagnosis or complication of hemothorax, blood transfusions, tube thoracostomy, tracheostomy, LOS, or mortality rates. Similar findings are present in the subgroup of patients studied with high kinetic energy mechanism of injury. Our study does not support the perceived morbidity of APAC therapy in patients with severe blunt chest injury.

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Section: Methodsmentioning

confidence: 99%

Impact of Anticoagulant and Antiplatelet Use on Outcomes in Blunt Chest Injury

Udekwu

Roy

Stiles

et al. 2019

The American Surgeon

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“…The higher VAS score before surgery indicated that the pain symptoms were obvious, and the postoperative score was significantly reduced, which proved that the new technology alleviated the discomfort of patients. Early pain control can promote patients to do early rehabilitation exercises and reduce the incidence of lung infection, urinary tract infection, and deep venous thrombosis of lower limbs ( 31 , 32 ). The operative time of 5 patients with flail chest was short, and the external fixation of a 3D-printed guide with steel wire and adjustment of guide position accounted for most of the time.…”

Section: Discussionmentioning

confidence: 99%

“…While having the 3D-printed external fixation guide, patients can easily perform early activities without long-term bed rest, which decreases the occurrence of deep vein thrombosis, hypostatic pneumonia, and pressure soreness. Early thoracic support can support the formation and shaping of primitive callus ( 32 ). During this period, as the soft tissue edema subsides, we can refix the guide by adjusting the tightness of the steel wire as required to ensure that the guide closely fits the chest wall soft tissue.…”

Section: Discussionmentioning

confidence: 99%

3D-printed external fixation guide combined with video-assisted thoracoscopic surgery for the treatment of flail chest: a technical report and case series

Hu,

Sun,

Bao

et al. 2023

Front. Surg.

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BackgroundFlail chest is a common and serious traumatic condition in thoracic surgery. The treatment of flail chest often includes open reduction and internal fixation, which is relatively traumatic, complicated, and expensive. As three-dimensional (3D) printing technology is widely used in the clinical field, the application of 3D-printed products to chest trauma will become a new treatment option. To date, the use of 3D-printed external fixation guides for flail chests has not been reported. Thus, we aimed to assess the short-term efficacy of a new technology that treated flail chests with an individualized 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery (VATS).Patients and methodsA retrospective analysis was performed on patients with flail chest treated with this new technique at our center from January 2020 to December 2022. The following parameters were included: operative time, thoracic tube extraction time, intensive care unit time, thoracic volume recovery rate, visual analog scale score 1 month postoperatively, and postoperative complication rate. All patients were followed up for at least 3 months.ResultsFive patients (mean age: 45.7 years) were enrolled; they successfully underwent surgery without chest wall deformity and quickly returned to daily life. The average number of rib fractures was 8.4; all patients had lung contusion, hemopneumothorax, and anomalous respiration. The abnormal breathing of all patients was completely corrected on postoperative day 1, and the chest wall was stable. One case experienced mild loosening of the 3D-printed guide postoperatively; however, the overall stability was not affected. The other four cases did not experience such loosening because we replaced the ordinary silk wire with a steel wire. All cases were discharged from the hospital 2 weeks postoperatively and returned to normal life 1 month after the removal of the 3D-printed guide on average. Only one case developed a superficial wound infection postoperatively, and no perioperative death occurred.ConclusionsThe 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery is a novel technique in the treatment of flail chest and is safe, effective, feasible, and minimally invasive, with satisfactory clinical efficacy.

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“…Т яжелая травма груди остается одной из главных составляющих в формировании догоспитальной и госпитальной морбидности и летальности в среде всех пострадавших с повреждениями различного происхождения, вида и тяжести [1,2,3]. Пострадавшие с множественными и флотирующими переломами ребер представляют собой одну из наиболее сложных в тактическом и методологическом аспектах категорий пациентов с травмой груди [4,5,6]. Это связано с частым сочетанием тяжелых повреждений костного каркаса и внутренних органов, что обусловливает развитие дыхательной недостаточности и шока и тем самым объясняет непростую задачу выбора целенаправленного подхода к достижению стабилизации грудной клетки и устранению повреждений внутренних органов [7,8].…”

Section: Introductionunclassified

Modern Algorithms of Thoracic Cage Stabilization in Patients With Multiple Rib Fractures and Flail Chest

Benyan

Benian²,

Корымасов

et al. 2018

Science and Innovations in Medicine

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Objectives - to improve the treatment results in patients with multiple rib fractures and flail chest via the development and implementation of modern therapeutic and tactical algorithms. Material and methods. A non-randomized prospective study has been carried out to evaluate the results of treatment in 198 patients with multiple rib fractures and flail chest in the period of 2011-2017. Three clinical types were identified: 1) patients with multiple rib fractures with disordered thoracic cage structure - 77 (38.9%); 2) patients with flail chest - 71 (35.9%); 3) patients with multiple rib fractures without disordered thoracic cage structure - 50 (25.2%). There were developed and applied the diagnostic and treatment algorithms depending on the severity of injures of sternocostal frame and intrapleural organs, the presence and severity of associated injuries and background diseases, the conditions of medical aid. Results. The treatment tactics of all patients was based on the differentiated, staged and combined use of various methods of stabilizing the thoracic cage including the advanced types of medical care. Surgical stabilization methods were used in 162 patients, in 26 of them a combination of surgical techniques was applied, in 20 - the internal pneumatic stabilization, in 42 - the conservative treatment was performed. The retrospective analysis and the obtained results compared to the results of the equivalent historical group allowed us to state the decrease of mechanical ventilation time from 11.0 ± 3.9 to 5.1 ± 3.2 days (t = 1.17; p> 0.05), the length of stay in the ICU from 11.5 ± 5.4 to 6.8 ± 3.7 days (t = 0.72; p> 0.05), the complications frequency from 36.5% to 15.9% and mortality rate from 22.3% to 8.7%. Conclusion. Modern diagnostic and treatment algorithms in patients with multiple rib fractures and flail chest are based on stage-by-stage application, succession and combination of various methods of the thoracic cage stabilization throughout the medical assistance process. The algorithms, allowing to stabilize the thorax and to improve the condition of the patients in general, make it possible to realize the full potential of modern thoracic surgery.

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Flail Chest: Influence on Length of Stay and Mortality in Blunt Chest Injury

Cited by 6 publications

References 17 publications

Impact of Anticoagulant and Antiplatelet Use on Outcomes in Blunt Chest Injury

Impact of Anticoagulant and Antiplatelet Use on Outcomes in Blunt Chest Injury

3D-printed external fixation guide combined with video-assisted thoracoscopic surgery for the treatment of flail chest: a technical report and case series

Modern Algorithms of Thoracic Cage Stabilization in Patients With Multiple Rib Fractures and Flail Chest

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