Nonintubated minimally invasive chest wall stabilization for multiple rib fractures: a prospective, single-arm study
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(2020) 15:53
RESEARCH ARTICLE
Open Access
Nonintubated minimally invasive chest wall stabilization for multiple rib fractures: a prospective, single-arm study Weigang Zhao1†, Yonglin Chen2†, Weiwei He1, Yonghong Zhao1 and Yi Yang1*
Abstract Background: Nonintubated video-assisted thoracoscopic surgery has been widely reported in the past decade, while nonintubated chest wall stabilization has not been reported previously. The aim of this study was to evaluate the safety and feasibility of nonintubated minimally invasive chest wall stabilization in patients with multiple rib fractures. Methods: We conducted a prospective, single-arm, observational study. In this prospective study, 20 consecutive patients with multiple rib fractures were treated using nonintubated minimally invasive chest wall stabilization. Results: Minimally invasive chest wall stabilization was mostly performed for lateral rib fractures in this study (n = 8). The mean operation time was 92.5 min, and the mean blood loss was 49 ml. No patient required conversion to tracheal intubation. The mean extubation time of the laryngeal mask was 8.9 min; the mean postoperative fasting time was 6.1 h; the mean postoperative hospital stay was 6.2 days; the mean amount of postoperative drainage was 97.5 ml; the mean postoperative pain score was 2.9 points at 6 h, 2.8 points at 12 h, and 3.0 points at 24 h; and the mean postoperative nausea and vomiting score was 1.9 points at 6 h, 1.8 points at 12 h, and 1.7 points at 24 h. Conclusions: Nonintubated minimally invasive chest wall stabilization is safe and feasible in carefully selected patients. Further studies with a large sample size are warranted. Trial registration: ChiCTR1900025698. Registered on 5 September 2019. Keywords: Nonintubated, Minimally invasive, Chest wall stabilization, Rib fracture
Introduction Chest wall stabilization (CWS) has been widely performed in patients with multiple rib fractures worldwide in the past two decades with satisfactory outcomes [1]. It is generally accepted that patients with three or more acutely displaced rib fractures or flail chest should be considered for CWS [2]. However, there are still many patients with multiple rib fractures who refuse to accept * Correspondence: [email protected] † Weigang Zhao and Yonglin Chen contributed equally to this work. 1 Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China Full list of author information is available at the end of the article
CWS. One major concern for the above situation is that the trauma caused by surgery is too great. Under this circumstance, developing new methods to reduce surgical trauma in CWS is very important. Double-lumen endotracheal tube and one-lung ventilation has been considered a safe and conventional routine methodology for thoracic surgery. However, adverse events such as sore throat, pain, hoarseness, and respiratory complications are not uncommon after conversional intubation and general anesthesia [3, 4]. Compared with g
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