Flail chest--pathophysiology, treatment and prognosis.

Multiple injury is often associated with an unstable serial rib fracture and a pulmonary contusion under the contact area which both lead to respiratory insufficiency. This has to be treated at an ICU by respirator with IMV and PEEP from the beginning. With this method the time of respirator treatment has been lowered to nearly one half and tracheostomy is seldom needed. Also, the required oxygen concentration is less (35%) which decreases the risk of toxic pulmonary injury. The prognosis is poorer with head injury or other concomitant injury, especially severe trauma causing bleeding in parenchymatous organs of the abdomen.