Document Detail


Selective use of ventilator therapy in flail chest injury.
MedLine Citation:
PMID:  7005549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We have prospectively treated 36 patients with flail chest using a treatment protocol for limited use of mechanical ventilation. Age of the patients ranged from 6 months to 83 years. Patients were divided into three groups dependent upon their clinical presentation and need for respiratory support: Group I patients had severe pulmonary dysfunction-tachypnea, dyspnea, arterial PO2 less than or equal to 60 torr, arterial PCO2 greater than or equal to 50 torr or shunt fraction greater than or equal to 25%. Group II patients had no pulmonary dysfunction but did require temporary respirator support for an associated injury. Group III patients had no pulmonary dysfunction. Thirteen patients were assigned to Group I. They required respiratory support for an average of 10.5 days; 11 of the 13 had complications, and there were two deaths in this group resulting from a combination of respiratory failure and myocardial infarction. Seven patients were assigned to Group II. six patients were extubated immediately postoperatively; one patient with a head injury was hyperventilated for 48 hours to reduce intracranial pressure and then extubated. Sixteen patients were assigned to Group III. Fifteen required no ventilatory support. One 83-year-old man developed pneumonia and was mechanically ventilated for 31 days. Early effective pain control and chest physiotherapy were critical to success and were used in all patients. Increase in respiratory rate, fall in tidal volume or vital capacity, and increased pain were used as criteria for administration of analgesia. Nonventilatory therapy of flail chest reduces morbidity, mortality, and hospital cost.
Authors:
S R Shackford; R W Virgilio; R M Peters
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  81     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1981 Feb 
Date Detail:
Created Date:  1981-03-27     Completed Date:  1981-03-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  194-201     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Child
Child, Preschool
Female
Flail Chest / complications,  diagnosis,  therapy*
Humans
Infant
Intermittent Positive-Pressure Ventilation
Male
Middle Aged
Positive-Pressure Respiration
Respiration, Artificial* / adverse effects
Thoracic Injuries / therapy*
Grant Support
ID/Acronym/Agency:
GM 17284/GM/NIGMS NIH HHS; HL 13172/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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