Oscillating Positive Expiratory Pressure (OPEP) Therapy in Trauma Patients With Multiple Rib Fractures: A Randomized Comparative Trial Against Incentive Spirometry

Blunt trauma patients with rib fractures were studied to determine whether the number of rib fractures or their patterns were more predictive of abdominal solid organ injury and/or other thoracic trauma. Rib fractures were characterized as upper zone (ribs 1 to 4), midzone (ribs 5 to 8), and lower zone (ribs 9 to 12). Findings of sternal and scapular fractures, pulmonary contusions, and solid organ injures (liver, spleen, kidney) were characterized by the total number and predominant zone of ribs fractured. There were 296 men and 14 women. There were 38 patients with scapular fracture and 19 patients with sternal fractures. There were 90 patients with 116 solid organ injuries: liver (n = 42), kidney (n = 27), and spleen (n = 47). Lower rib fractures, whether zone-limited or overlapping, were highly predictive of solid organ injury when compared with upper and midzones. Scapular and sternal fractures were more common with upper zone fractures and pulmonary contusions increased with the number of fractured ribs. Multiple rib fractures involving the lower ribs have a high association with solid organ injury, 51 per cent in this series. The increasing number of rib fractures enhanced the likelihood of other chest wall and pulmonary injuries but did not affect the incidence of solid organ injury.

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Management of patients with multiple rib fractures

American Journal of Critical Care ◽

10.4037/ajcc2001.10.5.320 ◽

2001 ◽

Vol 10 (5) ◽

pp. 320-327 ◽

Cited By ~ 52

Author(s):

A Easter

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Pain Management ◽

Respiratory System ◽

Pain Control ◽

Rib Fractures ◽

Respiratory Care ◽

Trauma Patients ◽

Significant Morbidity ◽

Multiple Rib Fractures

Multiple rib fractures in trauma patients are associated with significant morbidity and mortality. Delayed morbidity for patients with rib fractures is often a result of hypoventilation leading to atelectasis, pneumonia, and respiratory failure. Pain management was first recognized as an important factor in preventing complications in these patients. Later, management of the respiratory system became more widely recognized as a major factor in patients' care. It is now known that patients with multiple rib fractures benefit most from adequate pain control, rapid mobilization, and meticulous respiratory care to prevent complications. A protocol based on a synthesis of the existing literature is developed. Development of such a protocol for decisions about rapid mobilization, respiratory support, and pain management is the first step in testing the hypothesis that these interventions will decrease the length of patients' stay in intensive care units.

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Hypoglycaemic Shock: Normal or Abnormal Response to Injury?

Tropical Doctor ◽

10.1177/004947559802800319 ◽

1998 ◽

Vol 28 (3) ◽

pp. 177-178

Author(s):

R O Ofiaeli ◽

C C Anyaegbu ◽

C E Dioka

Keyword(s):

Road Traffic Accident ◽

Traffic Accident ◽

Road Traffic ◽

Metabolic Response ◽

Rib Fractures ◽

Trauma Patients ◽

Lumbar Region ◽

Profuse Sweating ◽

Multiple Rib Fractures ◽

Abnormal Response

We report a case of hypoglycaemic shock which occurred in a patient 18 h after injury. The patient was involved in a road traffic accident and sustained multiple rib fractures and bruising in the (R) lumbar region. Eleven hours after his last meal he developed sudden weakness, profuse sweating, air hunger, thirst, disorientation and suddenly lapsed into coma 18 h after admission. Administration of 50 ml of 50% dextrose resulted in immediate restoration of consciousness. This case shows that this complication can occur in trauma patients even though the metabolic response to trauma is usually assumed to be hyperglycaemic.

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Epidemiology of combined clavicle and rib fractures: a systematic review

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01701-4 ◽

2021 ◽

Author(s):

Arthur A. R. Sweet ◽

Reinier B. Beks ◽

Frank F. A. IJpma ◽

Mirjam B. de Jong ◽

Frank J. P. Beeres ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Rib Fractures ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Multiple Rib Fractures ◽

Polytrauma Patients ◽

Clavicle Fractures

Abstract Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14th of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant–Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56–60.6% versus 29% in patients without clavicle fractures. Vice versa, 14–18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.

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Use of continuous intercostal nerve blockade is associated with improved outcomes in patients with multiple rib fractures

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000600 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000600

Author(s):

Rindi Uhlich ◽

Jeffrey David Kerby ◽

Patrick Bosarge ◽

Parker Hu

Keyword(s):

Hospital Mortality ◽

Standard Care ◽

Intercostal Nerve ◽

Rib Fractures ◽

Attractive Potential ◽

Trauma Patients ◽

Control Analysis ◽

Day Hospital ◽

Nerve Blockade ◽

Multiple Rib Fractures

BackgroundRib fractures are common among trauma patients and may result in significant morbidity and mortality. There are numerous treatment options, but ideal management is unclear. Delivery of local anesthetic via an analgesia catheter for continuous intercostal nerve blockade offers an attractive potential option for management of patients with rib fractures.MethodsWe performed a single-center, retrospective case–control analysis of trauma patients with multiple rib fractures from 2016 to 2018, comparing patients managed with continuous intercostal nerve blockade with standard care. Matching was performed in a 2:1 ratio by Injury Severity Score, age, and gender. Respiratory morbidity potentially secondary to rib fractures, including unplanned intubation, failure of extubation, need for tracheostomy, pneumonia, or mortality, were all identified and included. Potential complications due to catheter insertion were identified to be recorded. The primary outcome of interest was 30-day hospital-free days.ResultsNine hundred and thirty-three patients were eligible for analysis, with 48 managed using intercostal blockade compared with 96 matching controls. No complications of intercostal blockade were identified during the study period. Controls demonstrated fewer rib fractures (6.60±4.11 vs. 9.3±3.73, p=0.001) and fewer flail segments (0.8±1.76 vs. 2.0±2.94, p=0.02). Those managed with intercostal blockade demonstrated significantly more 30-day hospital-free days (15.9±6.43 vs. 13.2±9.94, p=0.048), less incidence of pneumonia (4.2% vs. 16.7%, p=0.03), and lower hospital mortality (2.1% vs. 13.5%, p=0.03). When adjusting for number of rib fractures and number of flail segments, use of continuous intercostal nerve blockade was significantly associated with lower hospital mortality (OR 0.10; 95% CI 0.01 to 0.91), pneumonia (OR 0.15; 95% CI 0.03 to 0.76), or need for tracheostomy (OR 0.23; 95% CI 0.06 to 0.83).DiscussionThe addition of continuous intercostal nerve blockade may help to improve outcomes in patients with multiple rib fractures compared with standard care alone.Level of evidenceTherapeutic/care management; level IV.

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Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2017.50.5.346 ◽

2017 ◽

Vol 50 (5) ◽

pp. 346-354 ◽

Cited By ~ 9

Author(s):

Hyun Oh Park ◽

Dong Hoon Kang M.D. ◽

Seong Ho Moon ◽

Jun Ho Yang ◽

Sung Hwan Kim ◽

...

Keyword(s):

Risk Factors ◽

Rib Fractures ◽

Trauma Patients ◽

Multiple Rib Fractures

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THE CLINICAL MANAGEMENT OF BLUNT TRAUMA PATIENTS WITH UNILATERAL MULTIPLE RIB FRACTURES

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199112000-00038 ◽

1991 ◽

Vol 31 (12) ◽

pp. 1716

Author(s):

S Gabram ◽

R Schwartz ◽

L Jacobs ◽

D Lawrence ◽

W Kantor ◽

...

Keyword(s):

Blunt Trauma ◽

Clinical Management ◽

Rib Fractures ◽

Trauma Patients ◽

Multiple Rib Fractures

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Early Use of a Chest Trauma Protocol in Elderly Patients with Rib Fractures Improves Pulmonary Outcomes

The American Surgeon ◽

10.1177/000313481908500334 ◽

2019 ◽

Vol 85 (3) ◽

pp. 288-291 ◽

Cited By ~ 1

Author(s):

Katherine M. Kelley ◽

Jessica Burgess ◽

Leonard Weireter ◽

Timothy J. Novosel ◽

Krista Parks ◽

...

Keyword(s):

Noninvasive Ventilation ◽

Chest Trauma ◽

Standard Procedure ◽

Rib Fractures ◽

Trauma Patients ◽

Ctrl Group ◽

Multiple Rib Fractures ◽

Trauma Population ◽

Inflammatory Drugs ◽

One Year

Rib fractures are among the most common injuries identified in blunt trauma patients. Morbidity increases with increasing age and increasing number of rib fractures. The use of noninvasive ventilation has been shown to be helpful as a rescue technique avoiding intubation in patients who have become hypoxemic but little data with regard to its use to prophylactically prevent worsening respiratory status are available. We developed a chest trauma protocol for our “elderly” (>45 years) trauma patients and sought to determine whether this would improve pulmonary outcomes. We retrospectively reviewed our elderly chest trauma patients one year before (CTRL) and nine months after implementation (STU) of the chest trauma protocol. The protocol consisted of intravenous narcotics, oral nonsteroidal anti-inflammatory drugs, prophylactic noninvasive ventilation, and measurements of incentive spirometry. In the control year, there were 176 patients meeting study criteria, whereas 140 met the criteria in the STU group. The CTRL group had 11 unplanned ICU admissions (rate 0.063), six unplanned intubations (rate 0.034), and eight patients diagnosed with pneumonia (rate 0.045). These rates decreased in the STU group to two unplanned ICU admissions (0.014, P = 0.044), one unplanned intubation (rate 0.007, P = 0.138), and no patients with pneumonia (0.0, P = 0.010). Our chest trauma protocol has significantly decreased adverse pulmonary events in our older blunt chest trauma population with multiple rib fractures. This protocol has become our standard procedure for patients older than 45 years admitted with rib fractures.

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Intraoperative evaluation by ultrasound of multiple rib fractures in trauma patients

The Journal of Cardiothoracic Trauma ◽

10.4103/jctt.jctt_7_20 ◽

2021 ◽

Vol 6 (1) ◽

pp. 28

Author(s):

Mauricio Velasquez ◽

Gustavo Cruz ◽

AlvaroI Sanchez ◽

JuanCarlos Puyana

Keyword(s):

Rib Fractures ◽

Trauma Patients ◽

Multiple Rib Fractures ◽

Intraoperative Evaluation

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