Flail Chest

A complication of multiple RIB FRACTURES; RIB and STERNUM fractures, or thoracic surgery. A portion of the THORACIC WALL becomes isolated from the RIB CAGE and exhibits paradoxical respiration.

Also Known As:

Networked: 278 relevant articles (21 outcomes, 21 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Rib Fractures (Rib Fracture)
2.	Pneumonia (Pneumonitis)
3.	Pain (Aches)
4.	Wounds and Injuries (Trauma)
5.	Congenital Abnormalities (Deformity)

Experts

1.	Majercik, Sarah: 3 articles (12/2021 - 07/2014)
2.	White, Thomas W: 3 articles (12/2021 - 07/2014)
3.	Puente, Ivan: 3 articles (08/2021 - 01/2018)
4.	Wycech, Joanna: 3 articles (08/2021 - 01/2018)
5.	Van Lieshout, Esther M M: 3 articles (11/2020 - 01/2019)
6.	Wijffels, Mathieu M E: 3 articles (11/2020 - 01/2019)
7.	Mayberry, John C: 3 articles (05/2009 - 11/2003)
8.	Kocher, Gregor J: 2 articles (01/2022 - 01/2017)
9.	Lardinois, Didier: 2 articles (01/2022 - 05/2015)
10.	Wiese, Mark Nikolaj: 2 articles (01/2022 - 05/2015)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Flail Chest:

1.	TitaniumIBA 01/01/2022 - "Titanium plates were first introduced for treating a traumatic flail chest, which yielded promising results in restoring chest wall stability. " 01/18/2023 - "Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center." 04/01/2022 - "The claw-type titanium plate has been successfully applied to manage a flail chest. " 08/12/2021 - "We report two successful cases for which a combination of two existing techniques, modified Robicsek wire fixation and locked titanium plate fixation, was applied to transverse sternal fracture with flail chest. " 01/01/2018 - "Surgical reconstruction of traumatic flail chest with titanium plaques."
2.	TeaIBA 04/01/2023 - "ESPB can achieve adequate analgesia in traumatic flail chest equivalent to that of TEA with significant improvement of arterial oxygenation and pulmonary functions and without serious adverse effects." 04/01/2023 - "The aim of this study was to compare the analgesic effects of ultrasound-guided erector spinae plane block (ESPB) with thoracic epidural analgesia (TEA) in patients with traumatic flail chest. " 04/01/2023 - "Sixty patients aged 18 - 60 years, ASA I-II, with unilateral flail chest were allocated into TEA group with a loading dose of 6 ml bupivacaine 0.25% and 2 μg/ml fentanyl and ESPB group with a loading dose of 20 ml bupivacaine 0.25% and 2 μg/ml fentanyl. "
3.	Midazolam (Versed)FDA LinkGeneric 12/01/2023 - "Although historically managed with supportive care, patients with multiple rib fractures and flail chest increasingly undergo SSRF, and so the anesthesiologist must be well-versed in the perioperative management and pain control for these patients, as controlling pain in this population is associated with decreased length of stay and improved outcomes. "
4.	Analgesics (Analgesic Drugs)IBA 02/08/2015 - "The majority of reviewed papers recommended a multi-disciplinary approach including allied health (chest physiotherapy and nutritionist input), nursing, medical (analgesic review) and surgical intervention (stabilisation of flail chest). " 04/01/2023 - "The aim of this study was to compare the analgesic effects of ultrasound-guided erector spinae plane block (ESPB) with thoracic epidural analgesia (TEA) in patients with traumatic flail chest. "
5.	SolutionsIBA 07/01/2022 - "The aim of this study was to evaluate the flail chest complication and solution suggestions that may occur due to chest compressions applied during transportation."
6.	Shape Memory AlloysIBA 01/01/2010 - "The curative effect and long-term follow-up results were observed after internal fixation with a shape memory alloy embracing fixator in patients with multiple fractured ribs and flail chest from January 2006 to December 2009. " 01/01/2010 - "The present study was to explore curative effect and postoperative results of Ti-Ni shape memory alloy embracing fixator in patients with multiple fractured ribs and flail chest. "
7.	aldosterone secretion inhibitory factor (ASIF)IBA 01/01/2009 - "Here we present a case of traumatic flail chest in a patient with traumatic severe chest wall deformity treated by chest wall reconstruction with AO-ASIF [Arbeitsgemeindschaft fur Osteosynthesefragen (Association for the Study of Internal Fixation)] osteosynthesis plaque."
8.	titanium nickelide (Ni-Ti)IBA 01/01/2010 - "The present study was to explore curative effect and postoperative results of Ti-Ni shape memory alloy embracing fixator in patients with multiple fractured ribs and flail chest. "
9.	Oxygen (Dioxygen)IBA 12/01/2015 - "The management of flail chest includes early aggressive multimodal analgesia, adequate oxygen, and ventilatory support. " 02/01/2007 - "Isolated flail chest may be successfully managed with aggressive pulmonary toilet including facemask oxygen, CPAP, and chest physiotherapy. " 10/01/1979 - "Effects of contusion and flail chest on pulmonary perfusion and oxygen exchange." 02/01/2022 - "Flail chest is a common injury in blunt trauma which is usually treated with analgesia, oxygen, and other conservative measures. " 06/01/1996 - "The effect on ventilatory function of fixation of a flail segment in internal (FIP) and external (FEP) position and oxygen administration was studied in an experimental flail chest with pleural indemnity. "
10.	Polypropylenes (Polypropylene)IBA 05/01/1997 - "An unusual case of flail chest: surgical repair using Marlex mesh." 03/01/2022 - "An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap." 01/01/2002 - "Reconstruction using Marlex mesh combined with moldable metal plates was carried out to prevent flail chest in nine patients, resection alone was performed in five patients, and a muscular flap was used in two patients. " 01/01/2006 - "A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. "

Therapies and Procedures

1.	Artificial Respiration (Mechanical Ventilation) 01/01/1984 - "Patients with traumatic flail chest and paradoxical respiration need first of all immediate intubation and artificial respiration, afterwards operative stabilization is beneficial in selected patients. " 07/01/1978 - "Controlled mechanical ventilation has been the mainstay of treatment in the flail chest syndrome for more than 20 years, retrospective studies have recently suggested that the technique is unnecessary, and they infer that spontaneous ventilation or intermittent mandatory ventilation are equally effective. " 05/05/2020 - "The Nuss procedure is a new effective treatment for severe flail chest patients who cannot be weaned from prolonged mechanical ventilation in the last few years. " 04/01/2002 - "Thirty-seven consecutive severe flail chest patients who required mechanical ventilation were enrolled in this study. " 03/01/1980 - "[Spirometric study of flail chest treated by artificial respiration]."
2.	Mechanical Ventilators (Ventilator) 09/01/2014 - "Increasing attention has been directed towards operative rib fixation of traumatic flail chest; reported benefits include more rapid weaning from the ventilator, decreased intensive care unit stays, decreased complications and improved functional results. " 05/01/2017 - "Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management." 08/01/2023 - "Rib plating has been shown to be beneficial among certain populations, such as patients with flail chest and failure to wean from the ventilator in patients without primary pulmonary pathology. " 07/01/2023 - "Anterior flail chest frequency represents a significant case of ventilator insufficiency. " 12/01/2022 - "RF for isolated flail chest in obese patients is associated with decreased mortality and fewer ventilator days. "
3.	Critical Care (Surgical Intensive Care) 07/01/2023 - "CWR-treated patients experienced a greater number of fractured ribs, (8.3 vs 5.8, p<0.001), higher incidence of flail chest (84.9% vs 48.9%, p<0.001), higher admission to Critical Care (64.3% vs 44.1%, p<0.001), greater demand for ventilation (36.9% vs 25.6%, p=0.004) and a higher New Injury Severity Scale value (36.9 vs 34.6, p=0.003). " 01/01/2023 - "A retrospective observational study tracked a total of 376 flail chest patients admitted to the emergency intensive care unit (EICU) and surgical intensive care unit (SICU) at Zagazig University over 120 months. " 12/01/2014 - "Despite significant advances in critical care management, flail chest remains a clinically significant finding, with a mortality rate of up to 33%. " 05/01/2013 - "Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury." 01/01/2023 - "It has proven effective in patients with flail chest on mechanical ventilation in whom it decrease intensive care and hospital length and reduces mortality. "
4.	Length of Stay 04/01/2023 - "Traumatic flail chest results in respiratory distress and prolonged hospital stay. " 01/01/2022 - "Compared to unrestrained patients, restrained non-flail chest patients had a significantly decreased hospital length of stay (LOS) and intensive care unit LOS (P < 0.05). " 03/01/2020 - "For patients with a flail chest, shorter ICU length of stay was found to be associated with surgical rib fixation comparing with nonoperative treatment (5.5±1.9 vs. 6.7±2.1 days, P=0.011). " 01/01/2018 - "Group A, when compared with group B, had significantly lower Injury Severity Score, RFX, rates of flail chest, pulmonary coinjuries, and shorter hospital length of stay and intensive care unit length of stay. " 01/01/2018 - "Compared with the SMV group, the PMV group had a significantly larger number of fractured ribs (P < 0.01), higher rate of severe Glasgow Coma Scale (GCS ≤8) (P < 0.05) and flail chest (P < 0.001), higher TTSS (P < 0.001), or longer intensive care unit and hospital stay (both P < 0.001). "
5.	Conservative Treatment 05/24/2015 - "The objective of the study is to provide evidence for selecting the best treatment approach for severe flail chest by comparing surgical and conservative treatments. " 05/24/2015 - "Better short-term efficacy of treating severe flail chest with internal fixation surgery compared with conservative treatments." 08/01/2020 - "Therefore, if flail chest persists despite the appropriate conservative management to correct the flail chest, active surgical management is essential. " 06/01/2019 - "Between March 2013 and December 2017, 34 patients (23 males, 11 females; mean age 43.7±12.1 years; range, 20 to 74 years) with a flail chest who underwent early rib fixation were included in the surgical group and 29 patients with a flail chest (19 males, 10 females; mean age: 45.7±15.8 years; range, 24 to 74 years) who were followed with the conservative approach were included in the conservative treatment group between February 2012 and December 2017. " 05/24/2015 - "Results suggest that internal fixation surgery resulted in better outcomes in the management of severe flail chest compared with conservative treatments."