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J Crit Care. 2014 Feb;29(1):139-43. doi: 10.1016/j.jcrc.2013.08.003. Epub 2013 Sep 24.

Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation.

Author information

1
Department of Surgery, Division of Trauma and Emergency Surgery, Baystate Medical Center, Springfield, MA 01199, USA. Electronic address: Andrew.doben@baystatehealth.org.
2
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: evsurgery@gmail.com.
3
Division of Cardiothoracic Surgery, MUSC Ashley River Tower, Charleston, SC 29425, USA. Electronic address: denlinge@musc.edu.
4
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: leon@musc.edu.
5
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: couild@musc.edu.
6
Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address: fakhry@musc.edu.
7
Department of Surgery, University of Texas, Southwestern, Dallas, TX 75290, USA. Electronic address: ctminshall@gmail.com.

Abstract

PURPOSE:

The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma.

MATERIALS AND METHODS:

Patients with flail chest admitted between September 2009 and June 2010 to our level I trauma center who failed traditional management and underwent SRF were matched with an historical group. Outcome variables evaluated include age, injury severity score, intensive care unit length of stay (LOS), hospital LOS, ventilator days, total number of rib fractures, and total number of segmental rib fractures.

RESULTS:

The 2 groups were similar in age, injury severity score, intensive care unit LOS, hospital LOS, total number of rib fractures, and total segmental rib fractures. The operative group demonstrated a significant reduction in total ventilator days as compared with the nonsurgical group (4.5 [0-30] vs 16.0 [4-40]; P = .040). Patients with SRF were permanently liberated from the ventilator within a median of 1.5 days (0-8 days).

CONCLUSIONS:

Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.

KEYWORDS:

Flail chest; Mechanical ventilation; Outcome; Rib fracture; Surgical rib fixation; Trauma

PMID:
24075300
DOI:
10.1016/j.jcrc.2013.08.003
[Indexed for MEDLINE]

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