Management of 130 Cases of Chest Injury With Respiratory Failure

Gibbons, Jennifer; James, O.F.W.; Quail, Anthony W.

doi:10.1093/bja/45.11.1130

Cited by 19 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…'Internal pneumatic splinting' with some form of mechanical ventilation has become standard therapy in the management of flail chest and other major thoracic trauma. 106 It has been claimed that the early use of IMV and PEEP will shorten the period of assisted ventilation. 107 CPAP alone might be expected to reduce paradoxical movement of the flail segment and improve gas exchange, but controlled trials of its use have not been carried out.…”

Section: Flail Chestmentioning

confidence: 99%

PEEP and CPAP

Duncan

Hillman

1986

Anaesth Intensive Care

View full text Add to dashboard Cite

Positive end-expiratory pressure (PEEP) maintains airway pressure above atmospheric at the end of expiration, and may be used with mechanical ventilation or spontaneous breathing. CPAP, or continuous positive airway pressure, refers to spontaneous ventilation with a positive airway pressure being maintained throughout the whole respiratory cycle. PEEP/CPAP primarily improves oxygenation by increasing functional residual capacity, and may increase lung compliance and decrease the work of breathing. PEEP/CPAP may be applied using endotracheal tubes, nasal masks or prongs, or face masks or chambers to treat a wide range of adult and paediatric respiratory disorders. Complications associated with their use relate to the pressures applied and include pulmonary barotrauma, decreased cardiac output and raised intracranial pressure.

show abstract

Section: Flail Chestmentioning

confidence: 99%

PEEP and CPAP

Duncan

Hillman

1986

Anaesth Intensive Care

View full text Add to dashboard Cite

show abstract

“…Severe respiratory distress can also result from breathing-dependent pain where parenteral opioids are often insufficient in addressing the pain and associated respiratory failure. 3 epidural analgesia is associated with reduction in mortality for all patients with multiple rib fractures but is underused, in part due to the potential risks of epidural hematomas. 2,4 Variables that alter the risk of bleeding including age and sex, comorbidities such as diabetes and liver cirrhosis, severity of trauma and degree of resuscitation, and anticoagulation or antiplatelet therapy must also be considered.…”

mentioning

confidence: 99%

Pain-associated Respiratory Failure in Chest Trauma

et al. 2013

View full text Add to dashboard Cite

T he leading cause of death in young people is trauma. Chest trauma has high associated mortality, thus diagnosis and treatment need to be addressed early on presentation. 1 The incidence of rib fractures range from 10% to 26% in traumatic thoracic injury and the number of rib fractures independently predict patients' pulmonary morbidity and mortality.2 Numerous cardiopulmonary to neurologic causes such as tamponade, hemo-pneumothorax, and cervical spine injury can be implicated ( fig. 1). Severe respiratory distress can also result from breathing-dependent pain where parenteral opioids are often insufficient in addressing the pain and associated respiratory failure.3 epidural analgesia is associated with reduction in mortality for all patients with multiple rib fractures but is underused, in part due to the potential risks of epidural hematomas. 2,4 Variables that alter the risk of bleeding including age and sex, comorbidities such as diabetes and liver cirrhosis, severity of trauma and degree of resuscitation, and anticoagulation or antiplatelet therapy must also be considered.We describe a patient under clopidogrel therapy presenting to the intensive care unit (ICU) with severe respiratory distress that improved with epidural analgesia. We provide a discussion of the risks and benefits of neuraxial analgesia in patients presenting with rib-fracture pain-related respiratory failure. Case ReportA 79-yr-old man with a history of chronic obstructive pulmonary disease, bronchiectasis, coronary artery disease postplacement of bare-metal stent several years ago, hypertension, and diabetes was transferred to our hospital shortly after motor-vehicle collision. home medications were aspirin 325 mg, clopidogrel 75 mg per day (taken morning of accident), as well as inhaled tiotropium, inhaled fluticasone/ salmeterol, albuterol, isosorbide dinitrate, metformin, and simvastatin. On arrival, the patient was hemodynamically stable with pulse oximeter saturations of 94% on a nonrebreather mask with 60% inspired oxygen concentration. Computed tomography imaging revealed second to ninth anterior right rib fractures, fourth through ninth anterior left rib fractures, and posterior 10th and 11th left rib fractures, but without flail chest nor pneumothorax. A small left pleural effusion, left lung and lingular atelectasis, and minimal ground glass opacity in the right upper lobe, and a small right-lower lobe pulmonary contusion were shown ( fig. 2). The patient received 3 l lactated Ringer's solution before arriving in our ICU. his Injury Severity Score of 24 was primarily due to rib and lung injuries (16 points), then moderate head and surface injuries (4 points each).After admission to the surgical ICU, he developed increasing pain-related respiratory distress during the day. Tylenol was administered, and hydromorphone 0.2 mg intravenously produced somnolence, but minimal improvement of respiratory effort and pain. he had an electrocardiogram unremarkable for cardiac ischemia and negative cardiac isoenzymes and brain-natriuertic ...

show abstract

“…10 Severe pulmonary distress may cause breathing-dependent pain in which IV opioids are often inadequate in addressing pain and associated respiratory failure. 11 Especially, inadequate pain control despite numerous pain relief methods, such as paravertebral block, epidural block, IV continuous analgesia, and intercostal nerve block, may cause to postoperative pulmonary morbidities, such as secretion stasis, hypoxia, atelectasis, and pneumonia, by reducing respiratory and diaphragmatic function. 12 In patients with rib fractures, external methods such as lidocaine patch 5%, transdermal opioids, and Chrisofix® Chest Orthosis (CCO) are also used to reduce pain and accompanying complications.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Chrisofix® Chest Orthosis Application in Patients with Traumatic Rib Fractures

Işıklı,

Yanık,

Karamustafaoğlu

et al. 2024

Bangladesh J Med Sci

View full text Add to dashboard Cite

Background: The Chrisofix® Chest Orthosis is an effective and easy to use device for the treatment of rib fractures. It is used as a supportive treatment to reduce the pain levels and complication risks of the patients. Methods: Patients hospitalized with the diagnosis of rib fractures in the Thoracic Surgery Service of a university hospital were retrospectively scanned in an online computer program between October 2018 and October 2021. The study sample consisted of patients with the treatment (30) and control (30) groups. Results: Visual Analog Scale and incidence of atelectasis of the patients in the experimental group (The Chrisofix® Chest Orthosis) is statistically significantly lower than the control group (P < 0.05). In both the experimental and control groups, no statistically significant difference was found between the variables of patient’s demographic and clinical characteristics (p > 0.05). Conclusions: In the study, with the use of The Chrisofix® Chest Orthosis, a significant decrease was observed in the Visual Analog Scale and the incidence of atelectasis. Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 83-88

show abstract

Management of 130 Cases of Chest Injury With Respiratory Failure

Cited by 19 publications

References 0 publications

PEEP and CPAP

PEEP and CPAP

Pain-associated Respiratory Failure in Chest Trauma

Evaluation of Chrisofix® Chest Orthosis Application in Patients with Traumatic Rib Fractures

Contact Info

Product

Resources

About