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Abstract

Introduction: We pesent a successful treatment case of post-traumatic acute respiratory distress syndrome (ARDS) with severe flail chest by airway pressure release ventilation (APRV). A 63-year-old male was seriously injured in a traffic accident and brought to our hospital. He was diagnosed with multiple rib fractures, massive hemothorax, flail chest, lung contusion with blunt chest trauma and fractures of the pelvis and extremities. After two emergency thoracotomies for the thoracic hemorrhage, his pulmonary function was markedly deteriorated and acute respiratory distress syndrome developed. The Ventilator was set to pressure support (PS) mode (PS 15cmH2O, PEEP 15cmH2O), but the PaO2/FiO2 ratio decreased to 45mmHg. We reset the ventilator to APRV mode for this critical respiratory status. After a few hours, the PaO2/FiO2 ratio improved to 175mmHg. After getting this improved respiratory state, surgical stabilization for the multiple rib fractures could be performed safely on the 3rd day of admission. And he was weaned from the mechanical ventilation on the 8th day. The etiology of respiratory failure after multisystem trauma is multifactorial involving direct lung and chest wall injury, fluid sequestration within the lung after shock, resuscitation and reperfusion, and the elaboration of numerous inflammatory mediators from soft tissue and gastrointestinal sources. Decreased lung compliance can be severe and elevated airway pressures may be necessary to prevent life-threatening hypoxia. We therefore concluded that APRV is a preferable mode of ventilator support for post-traumatic ARDS with severe flail chest.