Flail chest injury-changing management and outcomes
Silvana F Marasco1,2, Jacqueline Nguyen Khuong3, Mark Fitzgerald4,5,6
1Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, VIC, 3004, Australia. S.Marasco@alfred.org.au.
Summary
Management of flail chest injuries has evolved, with increased use of regional anesthesia and surgical rib fixation. These advancements reduce mechanical ventilation and intensive care unit stays but do not affect patient mortality.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Anesthesiology
Background:
- Flail chest injuries present complex management challenges.
- Optimal treatment strategies for flail chest have been evolving.
- Understanding trends in flail chest management is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze trends in the management of flail chest injuries over a 12-year period.
- To evaluate the impact of these management trends on patient outcomes.
- To identify changes in treatment modalities for flail chest.
Main Methods:
- Retrospective review of a prospectively collected trauma database.
- Inclusion of patients with flail chest injury (AIS code) admitted between July 2008 and June 2020.
- Analysis of management trends, including regional anesthesia and surgical rib fixation.
Main Results:
- A significant increase in the use of regional anesthesia (15% per year) and surgical rib fixation (16% per year).
- A decrease in the requirement for and duration of invasive mechanical ventilation (14% per year).
- Reduced intensive care unit (ICU) length of stay by 9 hours per year.
Conclusions:
- Increasing adoption of regional anesthesia and surgical fixation for flail chest injuries.
- These trends correlate with reduced mechanical ventilation needs and shorter ICU stays.
- Mortality rates for flail chest patients remained unaffected by these management changes over the study period.
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