Flail Chest: Less Deadly than Originally Thought

Benjamin, Elizabeth; Recinos, Gustavo; Aiolfi, Alberto; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1007/s00268-018-4723-6

Cited by 26 publications

(30 citation statements)

References 25 publications

(26 reference statements)

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“…In another study, approximately, half of the flail chest cases were found to have additional trauma. [ 2 ] Considering that in flail chest cases evaluated in the present study, it can be said that the rate of multi-trauma is 75% and that nearly half of these cases suffered head and spine trauma, multi-trauma are, therefore, prevalent in flail chest patients and the findings obtained from the study are compatible with the literature. Researchers stated that multi-trauma seen in flail chest cases had negative effects on the treatment process; however, the effect of multi-trauma on treatment results was not sufficiently investigated.…”

Section: Discussionsupporting

confidence: 89%

“…The mortality rate in flail chest cases without multi-trauma was 5.6% whereas thoracotomy, mechanical ventilation, cardiac contusion, and sternal fracture have been found to increase the risk of mortality in isolated flail chest cases. [ 2 ] In a systematic review, it was reported that the mortality rate in flail chest cases ranged from 16% to 25%. [ 9 ] Therefore, according to the above studies, it can be said that the mortality rate in flail chest patients with multi-trauma is higher than in isolated flail chest patients and lower than the studies examining cases with multi-trauma.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] In a published study investigated national trauma data in the USA, the incidence of the flail chest was found 1.4% in more than one million chest trauma patients. [ 2 ] Moreover, 4.5% of patients with the flail chest were treated with surgical operation, and the rate of surgical operation has increased. [ 3 ] The mortality rate was 1.5% in flail chest cases who underwent rib stabilizations, whereas the mortality rate was 12.4% in the flail chest cases treated without surgery.…”

mentioning

confidence: 99%

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The Outcomes Of Chest Wall Stabilization In Flail Chest Patients In The Intensive Care Unit

Özdemir¹

2021

Sisli Etfal

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Objectives: In this study, the effect of multi-trauma on treatment results in flail chest patients who underwent chest wall stabilization was investigated. Methods: The data of thirty-six flail chest cases between the ages of 18–79 who were consulted for thoracic surgery were retrospectively analyzed in the study. The presence of flail chest in the patients was confirmed by thoracic surgeons, and the multi-traumas were confirmed through the diagnoses made by specialist physicians reexamining clinical methods. Results: It was found that 27 (75%) of flail chest cases evaluated had multi-trauma, and 3 (8.3%) of the cases had mortality in the study. It was found that the duration of the intensive care unit stay and the number of days on invasive mechanical ventilation of the cases were positively correlated with the number of surgical areas exposed to trauma (p<0.05). According to the univariate binary logistic regression analysis, it was found that the total number of rib fractures (OR = 1.44, p=0.055), the number of fixed ribs (OR = 0.76, p=0.558), the number of plates placed for fixation (OR = 0.70, p=0.368), and the number of additional trauma areas outside the thorax (OR = 6.76, p=0.076) were not statistically significant in increasing the mortality risk. Conclusion: Considering that multi-trauma is an effective factor in the prolongation of the duration of treatment, the management of traumas with different specialties can positively affect the treatment results and reduce the risk of mortality.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Outcomes Of Chest Wall Stabilization In Flail Chest Patients In The Intensive Care Unit

Özdemir¹

2021

Sisli Etfal

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“…There is evidence to suggest that flail chest is not as clinical deleterious as once thought, and was found to only require mechanical ventilation 30% of the time in 1 study. 8 Although we did collect information on flail chest, we did not use it as a matching criteria. The incidence of flail chest in case and control groups were within 10% of each other by virtue of the matching process.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Rib Fractures

Farley

Mullen

Taylor

et al. 2020

The American Surgeon

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Background Rib fractures are a major problem characterized by pain, increased length of stay, and respiratory complications. Treatments include fixation, management with opiates, paraspinous local anesthetic pumps, and intercostal nerve blocks. The aim of this study was to evaluate the use of treatment options and compare clinically relevant outcomes. Methods Patients admitted to a Level 1 trauma center with multiple rib fractures between 2015 and 2019 were screened. We included all participants treated with surgical fixation and/or intercostal nerve block or local anesthetic pump. Patients were case-matched 1:2 by Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) Chest and Head, age, and number of rib fractures. Outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, pneumonia, and tracheostomy rates. Results We identified 25 patients who received rib fixation and intercostal analgesia. Of these, 14 cases were treated with liposomal bupivaicaine nerve block and 11 by paraspinous catheter block. Fifty control cases treated with opiates were identified. All patients survived to discharge. Cases and controls were approximately equivalent in age, ISS, number of fractured ribs, chest AIS, and head AIS. Rib-plated patients had a lower rate of pneumonia (OR 0.2029, 95% CI 0.0242, 0.09718), decreased average ICU LOS (10.62 vs 6.64, P = .018), and decreased average ventilator days (5.44 vs 1.68, P = .003). Discussion Findings suggest more aggressive treatment of rib fractures may decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures. These findings are in line with current literature; however, more research is needed in this area.

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“…Dado que requiere una gran energía, existe una alta probabilidad de asociación a otras lesiones torácicas, abdominales o neurológicas. Aún cuando se trata de un cuadro muy grave su mortalidad es menor que lo esperado, situándose en la actualidad en alrededor del 5,6% [10].…”

Section: Tórax Volanteunclassified

Traumatismo torácico y anestesia

Garrido¹

2021

Rev. chil. anest.

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The thoracic trauma patient is generally of young, working age, and is often affected by multiple trauma. In its preoperative management, the functional repercussions secondary to thoracic injuries (pulmonary contusion, myocardial contusion, flail chest, etc.) should be evaluated. These become more important when anesthesia must be administered for surgical resolution of neurological, abdominal or limb injuries, and especially, when emergency thoracic surgery must be performed. Only 15% of patients with chest trauma require surgery. In emergency situations, regional techniques are limited to be a part of the postoperative analgesia or they are indicated in case of extensive nonsurgical parietal lesions. These are patients that have a full stomach in whom, in many cases, a chest drain must be installed prior to or during anesthetic induction. Induction agents that produce less hemodynamic compromise and maintenance with halogenated gases are suggested. Double-lumen endobronchial tubes are the standard method for providing lung isolation. Intraoperative mechanical ventilation should be provided considering the concepts of pulmonary protection taken from intensive medicine. Good postoperative analgesia facilitates respiratory physiotherapy, prevents deterioration of lung function, and allows early ambulation, helping altogether to reduce the incidence of pulmonary and thromboembolic complications.

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Flail Chest: Less Deadly than Originally Thought

Cited by 26 publications

References 25 publications

The Outcomes Of Chest Wall Stabilization In Flail Chest Patients In The Intensive Care Unit

The Outcomes Of Chest Wall Stabilization In Flail Chest Patients In The Intensive Care Unit

The Treatment of Rib Fractures

Traumatismo torácico y anestesia

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