From the Research
A flail chest does not inherently require a chest drain, but rather the presence of complications such as pneumothorax, hemothorax, or significant pleural effusion necessitates its insertion. The primary management of flail chest focuses on pain control, respiratory support, and stabilization of the chest wall 1. If imaging reveals air or fluid collection in the pleural space, a chest drain would be inserted, typically a 28-32 French tube for blood or 24-28 French tube for air 2. The decision to place a chest drain should be based on the specific complications present rather than the flail chest diagnosis alone.
Key Considerations
- Flail chest is a condition where multiple adjacent ribs are fractured in at least two places, creating a segment of chest wall that moves paradoxically during respiration.
- The presence of pneumothorax, hemothorax, or significant pleural effusion requires the insertion of a chest drain 2.
- Patients with flail chest require close monitoring for respiratory deterioration, as the paradoxical movement can lead to respiratory insufficiency.
- Surgical stabilization of the flail chest segment is considered an effective procedure in selected patients, leading to improvement of respiratory function 1.
Management Approach
- Pain control using medications like morphine 2-5mg IV every 4 hours, or regional anesthesia such as thoracic epidural.
- Respiratory support, which may include oxygen therapy or mechanical ventilation in severe cases.
- Stabilization of the chest wall, which may involve surgical stabilization in selected patients 1.
- Close monitoring for respiratory deterioration and insertion of a chest drain if complications arise.