The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit

Abstract

BACKGROUND: In the present study, we aimed to compare clinical results of conservative and surgical stabilization approaches and to investigate the effect of early reduction in patients with a flail chest. METHODS: 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. We applied early rib reduction on the first or the next day (within 24 to 36 h) of trauma. The length of hospitalization, the presence of pneumonia and septic complications in the postoperative period, mortality, mechanical ventilation duration, tracheostomy rate, respiratory function test results, and pain scores were recorded and compared between the groups. RESULTS: The length of stay in the hospital and intensive care unit, and duration of mechanical ventilation were statistically significantly higher in the conservative treatment group than the surgery group (p<0.001, p<0.001, and p<0.001, respectively). None of the patients required tracheostomy in the surgical group, while five patients required tracheostomy in the conservative treatment group (p=0.004). Mortality rates were 2.94% and 20.69% in the surgery and conservative treatment groups, respectively (p=0.027). Pain scores were statistically significantly different in favor of the surgical group compared to the conservative treatment group (p=0.0038 and p=0.044, respectively). CONCLUSION: The results of our study show that early fixation and weaning reduce the need for mechanical ventilation, length of hospitalization, the need for tracheostomy, and mortality rates. This approach also provides a significant improvement in the long-term pain complaints and pulmonary function tests of patients with a flail chest.