Diagnosis and treatment of traumatic flail chest and pulmonary contusion

The paradoxical movement of flail chest is set by the imbalance between forces related to pleural pressure and that generated by parasternal intercostal muscle.The respiratory distress and hypoxemia are not induced by flail status,but by the underlying lung parenchymal lesions,and contusion is viewed as the primary pathophysiologic problem.Flail chest is an uncommon consequence of blunt trauma.It is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury.It is easy to induce acute respiratory distress syndrome(ARDS) and respiratory failure.The purpose of this article was to analyze and discuss the latest progresses in the pathophysiology and treatment of flail chest.The indications and contraindications of operative fixation,mechanical ventilation and pain relief with epidural analgesia were summarized.Strategies of easing pain,favourable fixation of flail chest and assistant treatment of mechanical ventilation are also key measures for treating traumatic flail chest and pulmonary contusion.