Pressure control ventilation and minitracheotomy in treating severe flail chest trauma.
OBJECTIVE
To evaluate pressure control ventilation (PCV) delivered through a minitracheotomy in treating severe flail chest trauma.


METHODS
Case report.


METHODS
Intensive care unit of a trauma center.


METHODS
A 34-year-old woman affected by flail chest trauma and acute respiratory failure, who was initially treated with tracheal intubation to obtain internal pneumatic stabilization. The patient failed extubation and noninvasive mask treatment (pressure support ventilation plus PEEP) due to poor chestwall mechanics.


METHODS
Minitracheotomy was performed and ventilation was achieved with high levels of inspiratory pressure (PCV or assisted PCV) to overcome the resistance of the cannula (Mini-Trach II, Portex, ID 4 mm). Esophageal and carinal pressures were monitored. Ventilatory treatment was always performed with the full cooperation of the patient; the patient's glottic function was always intact. The patient was successfully treated with pressure control ventilation delivered through the Mini-Trach. After 7 days of PCV, the patient was switched to assisted PCV. On the 20th day after admission, she was weaned from mechanical ventilation.


CONCLUSIONS
We conclude that a suitable gas exchange and pneumatic stabilization in a flail chest condition can be achieved using minitracheostomic ventilation. At the same time, this treatment could reduce some side effects of traditional tracheal intubation.
Gregoretti
C
C
Intensive Care Unit of the Orthopedic and Trauma Center, Turin, Italy.
Foti
G
G
Beltrame
F
F
Giugiaro
P M
PM
Biolino
P
P
Burbi
L
L
Turello
M
M
Agostini
F
F
Berardino
M
M
Musto
P
P
D000328:Adult; D005260:Female; D005409:Flail Chest / Q000601:surgery* / Q000628:therapy; D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000601:surgery* / Q000628:therapy; D012129:Respiratory Function Tests; D014140:Tracheotomy; D015300:Ventilator Weaning