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Ann Thorac Surg 1975;19:355-363
© 1975 The Society of Thoracic Surgeons
From the Departments of Surgery and Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, Tex.
* Address reprint requests to Dr. Trinkle, Professor and Head, Division of Cardiothoracic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, Tex. 78284.
The pathophysiology of flail chest is usually described only on the basis of paradoxical respiration, ignoring underlying pulmonary contusion. Two groups of comparable patients were treated either with early tracheal intubation and mechanical ventilation (Group 1), or with fluid restriction, diuretics, methylprednisolone, albumin, vigorous pulmonary toilet, and intercostal nerve blocks, ignoring the paradox and treating only the underlying lung (Group 2). When tracheostomy and mechanical ventilation were not used the mortality rate went from 21% to 0 (p = 0.01), the complication rate from 100% to 20% (p = 0.005), and the average hospitalization from 31.3 to 9.3 days (p = 0.005). We conclude that most patients with flail chest do not need internal pneumatic stabilization if the underlying lung is treated appropriately and that tracheostomy and prolonged mechanical ventilation with a volume respirator, as practiced in most respiratory care centers, is usually a triumph of technique over judgment.
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