Noninvasive ventilation in large postoperative flail chest

Abstract

An 11-year-old male developed a severe respiratory failure due to a iatrogenic flail chest following a surgery for removing a large chest wall area. A rare Ewing sarcoma was histologically diagnosed and intensive chemotherapy was administered. Postoperatively, because of the failure in ventilation weaning, the patient was electively extubated and noninvasive positive pressure ventilation through face-mask was provided. Respiratory support avoided asynchronous paradoxical movements and achieved pneumatic stabilization. Clinical and respiratory improvement allowed a successful weaning from ventilator.

Relationship between paradoxical breathing and pleural diseases in dyspneic dogs and cats: 389 cases (2001–2009)

“…However, this relationship between PB and pleural diseases has been demonstrated in human medicine. For example, PB is reported to be a key symptom of diaphragmatic paresis in human patients, [8][9][10][11][12][13] although spontaneous diaphragmatic paresis was not observed in the present study. In people, PB has also been shown to be associated with neurologic diseases, 12,14 diaphragmatic myopathy, 9 flail chest, 10 chronic obstructive pulmonary disease, 15 upper airway obstruction, 16,17 severe abdominal distension, 18 and pleural effusion.…”

“…Increased inspiratory effort seems to be strong enough to aspirate the abdominal viscera toward the chest, resulting in sunken flanks when the ribs elevate and bulging flanks when the ribs depress. Various names have been assigned to this particular respiratory pattern, [5][6][7][8][9][10][11][12] the most common being PB or discordance. As the inspiratory efforts increase, the respiratory movements are marked.…”

Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure

“…Median age was 16 months (IQR 6,5; 33.50), while median body weight was 12 kg (IQR 6,2; 17) and M/F ratio 3.0; main diagnoses were bronchiolitis [ 12 ]; Acute respiratory distress syndrome (ARDS) [ 7 ] chest trauma [ 2 ], burn-associated respiratory failure [ 4 ], status asthmaticus [ 3 ], neurological illness [ 3 ], pneumonia [ 4 ], Bronchopulmonary Dysplasia [ 3 ] and post-operative patients [ 2 ]. Median Pediatric Risk of Mortality (PRISM)-III24 for the study group was 15.5 (IQR 12;22) (Table 1 ).…”

“…Noninvasive ventilation (NIV) has been reported as effective for treatment of respiratory failure associated with different respiratory diseases in childhood [ 1 , 2 ]. Its usefulness has also been suggested in postoperative and immunocompromised pediatric patients [ 3 , 4 ]. However, interface intolerance and agitation may represent a major clinical problem and a frequent cause of NIV failure.…”

Flail Chest Associated with a Simple Fall and Successful External Tamponade Application in a Pediatric Case

“…It may induce torsion of the superior and inferior vena cava, irrespective of the presence of pneumothorax, characterized by paradoxical movement of a segment of the chest wall. It leads to reduced cardiac output due to decreased blood supply to the heart, and triggering hypertension, syncope, and sudden cardiac arrest [6]. Therefore, early diagnosis and management of mediastinal flatter is critical in such patients [7].…”