Comparison of Continuous Mechanical Ventilation and Internal Fixation in Flail Chest Injuries

Kang, Chang Hee; Jang, In Sung; Lee, Kil Rho

Abstract

From January, 1992 to June, 1996, )7 patients with flail chest were treated at Sonnchunhyang university hospital. 15 patients were managed by internal fixation of fractured ribs, whereas the remaining 22 patients were managed by endotracheal intubation and intermittent positive-pressure ventilation alone. There were no difference between two groups in age, sex, the severity of injury to the chest wall and the nature of associated injuries. Average dur'Btion of assisted ventilation was 5.7 +/-1.7 days in the patients treated by internal fixation versus 8.7 +/-3.3 days In the patients treated by continuous me hanical ventilation. Average stay in the intensive care unit was 8.3 +/-3.9 days for the patients treated by internal fixation, whereas it was 13.2+/-4.1 days in the group treated by continuous mechanical ventilation alone. In the group treated by internal fixation, complications were 3 atelectases(20.0%), 1 pneumonia(6.7%), 2 operative wound problems(12.3%) and 1 barotrauma(6.7%). In the other group, 7 atelectases(31.8%), 4 pneumonitis(18.2%), 2 empyemas(9.1%) and 3 barotraumas(1).6%). The mortality rate was 13.3%(2/15) in the surgically treated patients, whereas it was 22.7%(5122) in the other group. The treatment of flail chest by internal fixation resulted in speedy recovery, decreased complications and mortalities, and better ultimatc cosmetic and functional results.