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. 2019 Jul-Sep;13(3):179-183.
doi: 10.4103/sja.SJA_699_18.

Management of traumatic flail chest in intensive care unit: An experience from trauma center ICU

Shashi P Mishra  1 , Manjaree Mishra  2 , Noor Bano  2 , Mohammad Z Hakim  1
Affiliations

Management of traumatic flail chest in intensive care unit: An experience from trauma center ICU

Shashi P Mishra et al. Saudi J Anaesth. 2019 Jul-Sep.

Abstract

Background/aim: The thoracic injury and related complications are responsible for upto 25% of blunt trauma mortality. This study is designed to compare these two popular ventilation modes in traumatic flail chest.

Materials and method: A total of 30 patients with thoracic trauma, aged 18-60 years, were enrolled in this study for a period of 1 year. The Thoracic Trauma Severity Score (TTSS) was used for assessing the severity of chest injury. Patients were divided into two treatment groups: one recieved endotracheal intubation with mechanical ventilation (ET group, n = 15) and another recieved noninvasive ventilation (NIV group, n = 15). All patients were observed for the duration of ventilatory days, complications such as pneumonia and sepsis, length of the stay in ICU, and mortality. Statistical analysis was done using statistical software SPSS for windows (Version 16.0).

Results: There were no significant differences in age, sex, weight, and length of the stay in ICU in between the two groups. Rate of complications was significantly higher in ET group. Oxygenation was significantly improved in NIV group within 24 hr, later it become equivalent to the ET group patients while the pCO2 level was significantly lower in ET group compared with NIV group. Analgesia in both the groups is maintained to keep the visual analog scale (VAS) score below 2 and was comparable in both the groups.

Conclusions: The endotracheal intubation is also associated with serious complications as compared to NIV. The use of NIV in appropriate patients decreases complications, mortality, length of the stay in ICU, the use of resources, and cost.

Keywords: Chest trauma; ICU; flail chest; rib fracture; ventilation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of mean heart rate (per minute) between two groups at different time intervals
Figure 2
Figure 2
Comparison of mean respiratory rate (per minute) between two groups at different time intervals
Figure 3
Figure 3
Comparison of mean pO2 (per mmHg) between two groups at different time intervals
Figure 4
Figure 4
Comparison of mean PCO2 (per mmHg) between two groups at different time intervals
Figure 5
Figure 5
Comparison of mean P/F ratio between two groups at different time intervals
See this image and copyright information in PMC

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