Treatment with internal pneumatic stabilization for anterior flail chest

Advantages and disadvantages have been reported for both internal pneumatic stabilization and surgical stabilization as treatments for anterior flail chest. We retrospectively investigated therapeutic outcomes and problems associated with pneumatic stabilization for anterior flail chest patients.

Subjects were 43 patients admitted to Tokai University Hospital with anterior flail chest, 1988-1999. Pneumatic stabilization was performed with continuous positive pressure ventilation and a positive end-expiratory pressure of 10 cm H20 or higher. We analyzed mean times required for pneumatic stabilization, weaning, and mechanical ventilation; sternal fracture (presence vs. absence); survival, and other clinical variables.

Continuous positive pressure ventilation was needed for 12.5 days and mechanical ventilation for 15.6 days. Flail chest was relieved by pneumatic stabilization alone in 42 patients; 1 patient with a displaced sternal fracture required sternal fixation. Four cases were complicated by pneumonia. Pneumatic stabilization allowed physicians to treat severe combined nonthoracic organ injuries during the acute phase. Forty patients survived, and 3 died from nonthoracic injuries (survival rate 93%).

Anterior flail chest unaccompanied by sternal fracture can be relieved by pneumatic stabilization alone. We hope to combine pneumatic stabilization with simple surgical stabilization in anterior flail chest patients to shorten the mechanical ventilation period.