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Chest wall distortion in patients with flail chest
G E Tzelepis1, F D McCool, F G Hoppin
1Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket 02860.
The American Review of Respiratory Disease
|July 1, 1989
Summary
Ventilator use can worsen chest wall distortion in flail chest patients. Continuous positive airway pressure with a high flow system (CPAP-HF) minimized this distortion, potentially aiding in weaning.
Area of Science:
- Respiratory Mechanics
- Thoracic Surgery
Background:
- Flail chest is characterized by significant chest wall distortion.
- Mechanical ventilators can impose loads that may exacerbate this distortion.
Purpose of the Study:
- To investigate the impact of ventilator loading on chest wall distortion in flail chest patients.
- To compare distortion across different ventilator modes.
Main Methods:
- Nine flail chest patients and four healthy subjects were studied.
- Chest wall distortion was measured using magnetometry during breathing on various ventilator modes (Assist Control, IMV, CPAP-HF, T-piece).
- Airway opening pressure was used to quantify ventilator loading.
Main Results:
- Flail chest patients exhibited chest wall distortion during spontaneous breaths, unlike normal subjects.
- Greater ventilator loading correlated with increased chest wall distortion.
- The continuous positive airway pressure with high flow (CPAP-HF) mode showed the least distortion, even reversing it in some patients.
Conclusions:
- Ventilator-imposed loads can increase chest wall distortion and work of breathing in flail chest patients.
- CPAP-HF may be beneficial in reducing distortion and potentially facilitating weaning.
- Ventilator management strategies should consider the impact on chest wall mechanics in flail chest.