Mechanical ventilation in the treatment of flail chest

Objective To discuss the indication of mechanical ventilation for fail chest, the management of ventilators, and the relationship between flail chest, pulmonary contusion and the respiratory failure. Methods A retrospective analysis was carried out on 66 cases of flail chest treated in our hospital from January 1996 to October 2004 that were divided into ventilatory treatment group (38 cases) and nonventilatory treatment group (28 cases) for comparison between the clinical features and treatment results. Results Posterior to combined mechanical ventilation including intermittent mandatory ventilation (SIMV) and positive end-expiratory pressure (PEEP), PaO_ 2 , PaCO_ 2 and pH were more significantly improved compared with pre-ventilation (P0.01). Nine cases died with overall mortality of 14%. There were four deaths (14%) in ventilatory treatment group and five (13%) in nonventilatory treatment group, with insignificant difference between both groups (P0.05). Conclusions (1) Ventilator therapy deserves recommend to treat flail chest, but the indications must be well controlled. (2) The indications for mechanical ventilation include presence of hypoxia and/or hypercapnia (PaO_ 2 60 mmHg, PaCO_ 2 55 mmHg), associated severe trauma with unconsciousness and/or shock state, bilateral flail chest and presence of airway obstruction or repeated atelectasis. (3) Shortening the duration of mechanical ventilation and preventing pulmonary infections are key measures to reduce the hospitalization.