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  • • Hypoxemia

    • Hypercarbia

    • Mechanical insufficiency

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Epidemiology

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  • • Trauma

    • Pain/weakness postoperatively

    • Debility of long-term illness

    • Bronchopleural fistula

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Symptoms and Signs

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  • • Hypoxemia

    • Evidence of chest trauma

    • Chest pain

    • Free-floating chest wall segment

    • Large air leak via wound or chest tube

    • Poor ventilatory effort (pain, debility)

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Laboratory Findings

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  • • Hypoxemia

    • Hypercarbia

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Imaging Findings

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  • Chest film: Multiple rib fractures

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  • • Often multifunctional basis, for example combination of injury, anesthetic, pain medications and muscle weakeners from catabolism; all factors must be addressed

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  • • ABG measurements

    • Chest film

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  • • Mechanical ventilation

    • Analgesia

    • Chest tube decompression

    • Chest wall stabilization

    • Occlusion of bronchopleural fistulas

    • Weaning and nutritional support (debility)

    • Tracheostomy (debility)

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Surgery

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Indications

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  • • Large bronchopleural fistula

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References

Tobin MJ. Weaning from mechanical ventilation: what have we learned? Respir Care. 2000;45:417.  [PubMed: 10780038]

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