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Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.

Abstract：

BACKGROUND:Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these patients. STUDY DESIGN:A prospective randomized study compared operative fixation of fractured ribs in the flail segment with current best practice mechanical ventilator management. In-hospital data, 3-month follow-up review, spirometry and CT, and 6-month quality of life (Short Form-36) questionnaire were collected. RESULTS:Patients in the operative fixation group had significantly shorter ICU stay (hours) postrandomization (285 hours [range 191 to 319 hours] for the surgical group vs 359 hours [range 270 to 581 hours] for the conservative group; p = 0.03) and lesser requirement for noninvasive ventilation after extubation (3 hours [range 0 to 25 hours] in the surgical group vs 50 hours [range 17 to 102 hours] in the conservative group; p = 0.01). No differences in spirometry at 3 months or quality of life at 6 months were noted. CONCLUSIONS:Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Marasco SF,Davies AR,Cooper J,Varma D,Bennett V,Nevill R,Lee G,Bailey M,Fitzgerald M

doi

10.1016/j.jamcollsurg.2012.12.024

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

924-32

issue

5

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(12)01429-9

journal_volume

216

pub_type

杂志文章,随机对照试验

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