The Use of Intermittent Positive Pressure Ventilation in the Management of Major Chest Wall Injury


INTRODUCTION. IT is generally accepted that patients with extensive chest wall injury, sufficiently severe to impair ventilatory function should, if possible, be treated in a specialised respiratory failure unit (Windsor and Dwyer, 1961). Such patients usually have associated injuries to the nervous system, the thoracic or abdominal viscera, or to other parts of the bony skeleton. They are often very ill, so that transfer to another hospital may be at best hazardous, and may possibly be out of the question. The introduction of tracheostomy and intermittent positive pressure respiration (I.P.P.R.) in the management of these cases by Avery, M6rch, and Benson has enabled patients with very severe crush injuries to the chest wall to be salvaged. The more general availability of efficient mechanical lung ventilators has made possible the use of this new method of treatment in the smaller general hospital to which the patient is often first admitted (Clarkson and Robinson, 1962). This paper presents a case where there was, besides a ruptured spleen and fractured skull, a severe bilateral chest wall injury, causing respiratory failure, successfully treated by I.P.P.R. in a small country hospital with limited anaesthetic cover. Some of the problems arising in the management of this type of case are discussed. Case Report. A young woman, aged 22 years, was admitted to hospital after involvement in a motor-car accident. On examination on admission:C.NS. She was unconscious, reacting only to painful stimuli. Pupils were equal and reacted sluggishly to light. Respiration was periodic in character. The right lower limb was spastic with a dorsi-flexor Babinski reflex while the left lower limb was normal. C.V.S. Heart rate was regular at 140 per minute and the blood pressure was 140/90. Chest. There were fractures of left fourth-eighth ribs apparent on clinical examination. Chest X-ray showed multiple bilateral rib fractures, and a right pneumothorax with some fluid present in the pleural space, but the chest wall was stable and lung ventilation was adequate. There were two lacerations on the left side of the head with a hxmatoma over the left parietal region. First Day. The patient's condition had deteriorated on the following day, the pulse had risen and blood pressure fallen. It was evident that there was internal

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@article{Nicholl1964TheUO, title={The Use of Intermittent Positive Pressure Ventilation in the Management of Major Chest Wall Injury}, author={Robert M. Nicholl and W. M. Pillow}, journal={The Ulster Medical Journal}, year={1964}, volume={33}, pages={36 - 42} }