An Investigative Study On The Management Of Flail Chest Using Chest Wall Surgical Fixation Versus Non-surgical Treatment And Research On The Occurrence And Development Of Pulmonary Infection Following Trauma

Objective: To explore the advantages and disadvantages on openreduction internal fixation (ORIF) for ribs fracture and non-surgicaltreatment in patients with flail chest, pulmonary infection and potential riskfactors for the development of infection in order to find the optimaltreatment option in patients with flail chest and lower chest wall stability andlate complications such as lung infections and mortality.Methods: There were109cases with flail chest from ChongqingEmergency Medical Center during June2003to August2013were analyzedretrospectively. The66cases which met the study inclusion criteria weredivided into surgical group (row rib fractures open reduction internalfixation, including the necessary exploratory thoracotomy) in33cases andnon-surgical group (chest surgery did not undergo at all) in33cases.25of66cases of patients with pulmonary infection, the patient’s temperature (T),heart rate (HR)/min, respiratory rate (RR)/min, white blood cell (WBC) in blood and other indicators were also recorded dynamically, combined withsputum culture results observed trends.Results:(1) the total cure rate was90.9%(60/66), the mortality rate was9.1%(6/66). Death was occurred in six cases. Three patients died of traumatic hemorrhagic shock, three patients died of lung infectionscomplicated by respiratory and circulatory failure due to multiple organ dysfunction syndrome (MODS).(2)Compared to the non-surgical group, the patient’s age (56.5±15.6vs52.6±12.5), prehospital time (2.2±2.4h vs3.9±4.7h), the number of rib fractures (7.9±4.0vs8.0±4.3), ISS (24.5±12.4vs26.4±11.2), RTS (7.7±0.2vs7.3±1.4),pulmonary contusion (69.7%vs72.7%), atelectasis (24.2%vs21.2%),mechanical ventilation rate (48.5%vs30.3%) in surgical group showed no significant difference (P>0.05). However, the statistically significant difference in mid to massive hemothorax incidence rate (36.4%vs6.1%), incidence rate of shock (33.3%vs9.1%), pulmonary infection (60.6%vs15.2%), hospital stay (27.3±22.0vs43.7±26.7), medical expenses (55721.0±46900.7vs89362.5±65749.0￥), chest wall deformity rate (0%vs75.8%), mortality (0%vs18.2%) were existed between the surgical group and non-surgical group (P <0.05).(3)The high risk fa-ctors for lung infection in flail chest were hemopneumothorax, mechanical ventilation, and previous related chronic bronchitis.(4)Pulmonary infection occurred in25cases (25/66,37.9%), it occurred on3rd to22day s (median=9.5days, quartile=12days) after injury; infection durationfor3-46days (median=11.5days, quartile=10.2days), antibiotic administration for5-58days (median=20.5days, quartile=23.5days). Themain pathogens of pulmonary infection were acinetobacter baumannii, pseudomonas aeruginosa, enterobacter cloacae, including one case of pulmonary fungal infection. The type of fever for undulant fever in six cases, intermittent fever in one case, remittent fever in one case, the restswere irregular heat.Conclusions:(1) The results suggested that there were some benefits bysurgical operation of ORIF for patients with flail chest. The flail chest can becorrected quickly, shorter hospital stays, lower treatment costs and mortality.(2) Hemopneumothorax, mechanical ventilation, and previous chronicbronchitis were risk factors for pulmonary infection in patients with flailchest.(3) The6-14days may be the peak period of pulmonary infection aftertrauma.To reduce infectious complications and pulmonary morbidity andimprove prognosis, it should be strengthened to respiratory physiotherapy,nebulization inhalation and help patients stand back, early tracheotomy andbronchoscopy lavage or sputum, as well as the important role of earlyidentification of lung infections and strengthen the comprehensive treatmentof anti-infection therapy, mechanical ventilation if necessary.