Application of a Portable Home Ventilator for Treating Flail Chest After Cardiopulmonary Resuscitation: A Case Report

Application of a Portable Home Ventilator for Treating Flail Chest After Cardiopulmonary Resuscitation: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case report Application of a Portable Home Ventilator for Treating Flail Chest After Cardiopulmonary Resuscitation: A Case Report Dong Hyup Lee, Young Uk Lee, Tae-Eun Jung This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-731108/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Unexpected cardiopulmonary resuscitation and subsequent flail chest are rare in cardiac surgery patients. A patient with a flail chest frequently requires long-term mechanical ventilator care. Early application of portable home ventilator (PHV) might be a useful treatment. Case presentation A 61-year-old female who underwent cardiac surgery had unexpected cardiopulmonary resuscitation with a flail chest. For treating her flail chest, portable home ventilator was applied with several respiratory rehabilitations. Conclusion We think PHV is useful and alternative treatment for inappropriate for surgical fixation in flail chest patients. Cardiac & Cardiovascular Systems Cardiothoracic Surgery Flail chest Cardiopulmonary resuscitation Portable ventilator Figures Figure 1 Figure 2 Background The incidence of unexpected cardiopulmonary resuscitation (CPR) after cardiac surgery is about 0.7–5.2%. It has reduced in recent years [ 1 – 3 ]. Skeletal chest injury after CPR can occur at a rate of 90%. The incidence of a flail chest after CPR is about 5% [ 4 , 5 ]. A patient with a flail chest frequently patient requires long-term mechanical ventilator care. Application of a portable home ventilator (PHV) is one last major step when treating patients who require long-term mechanical ventilation. For patients with flail chest, early application of PHV is important. Here, we present a case of a patient with a flail chest successfully treated with PHV. Case Report A 61-year-old Asian female patient was referred to our department with dyspnea and palpitation. The patient had been diagnosed with mitral stenosis (MS) 20 years previously. She was on medication. Severe MS and mild tricuspid valve regurgitation were confirmed by echocardiography. Atrial fibrillation was also observed on electrocardiogram. Based on the above findings, the patient underwent mitral valve replacement, tricuspid valve annuloplasty, and mini-Maze. She was extubated and treated in a general ward. On the 12th postoperative day, the patient underwent pericardial window formation due to cardiac tamponade with large hematoma. Five days after the window operation, the patient had unexpected cardiac arrest and survived after 25 minutes of CPR. On the follow-up echocardiography, the replaced valve and cardiac function were normal. We attempted ventilator weaning and extubation twice. However, respiratory failure progressed due to a flail chest. Chest wall reconstruction computed tomography was then conducted to evaluate the flail chest and for surgical planning (Fig. 1 A, 1 B). Right 3rd-7th and left 2nd-7th anterior arch of rib fractures and displaced sternum were observed. However, it was difficult to determine the surgical fixation site because the flail segment was not prominent and the fracture displacement was not severe (Fig. 1 C). Considering her nutritional state and previous two surgeries under general anesthesia, we decided to continue internal fixation with ventilator care. Tracheostomy was performed on the 19th day after CPR. After about 2 weeks of ventilator weaning, PHV was applied (Fig. 2 ) and the patient started respiratory rehabilitation including intermittent positive pressure ventilation, coughing machine, and diaphragmatic respiration. The patient was transferred to a general ward at 3 weeks after PHV application. On transfer to the general ward, the following settings were used: synchronized intermittent mandatory ventilation mode, O2 flow rate at 2 liter/minute, respiration rate of 8, and tidal volume of 350 ml. PHV support and lung rehabilitation were continued for another three weeks. After chest wall stabilization and self-sputum toileting were confirmed, PHV weaning was done and the tracheostomy site was sealed off. Subsequently, the patient was discharged without any specific findings (Fig. 1 D). She has been followed up at an outpatient clinic for three years. Currently, the patient activity is New York Heart Association classification I ~ II without any specific problems. Disccussion And Conclusion Flail chest is caused by paradoxical movement of a flail segment caused by intrathoracic negative pressure. It can increase respiratory effort and cause atelectasis, eventually enhancing mortality and complication rates [ 6 ]. Management of flail chest includes maintenance of adequate ventilation, fluid and pain management, and stabilization of the chest wall. Typically, treatment of an unstable chest wall involves internal stabilization using a ventilator or surgical fixation of the flail segment [ 6 ]. Both methods have their advantages and disadvantages. Recent studies have reported that surgical treatment produces better results in terms of pneumonia incidence, intensive care unit (ICU) and hospital stays, lung function, and cost than the use of a ventilator [ 7 – 10 ]. However, surgical treatment has the disadvantage of exposing patients to surgical stress comparable to that caused by a traumatic event [ 9 ]. Furthermore, rib fractures after CPR tend to be underestimated by imaging, which can make it difficult to locate the prominent flail segment [ 7 ]. In addition, as seen in our case, general anesthesia and surgical treatment might be difficult for cardiac surgery patients due to hemodynamic instability, anticoagulant use, or previous sternotomy. In patients who have difficulties after surgical treatment, the use of PHV might be a good alternative. Home ventilators are relatively easy to operate and portable. They can be applied in general wards. Early hospital application of PHV and general ward transfer have both short-term and long-terms benefits. In a short term, PHV protects patients from severe ICU infections, reduces delirium, and facilitates treatment by increasing the range of rehabilitation treatments that can be applied. For patients requiring long-term ventilator care due to COPD, neuromuscular disease, skeletal disorder, or permanent damage to lung function due to trauma, in-hospital application of PHV can provide a useful adaptation period for patients and caregivers. Recently, the use of noninvasive mechanical ventilation to avoid endotracheal intubation (ETI) has increased in the treatment of flail chest. Even if ETI and mechanical ventilation have been started, mechanical ventilation should be discontinued as soon as possible [ 11 ]. The importance of conservative treatment with rehabilitation and bedside treatment should not be overlooked. In the described case, respiratory rehabilitation was performed continuously, including intermittent positive pressure ventilation, coughing machine application, and diaphragmatic respiration. Bedside treatments such as manual percussion, encouraging ambulation, emotional support, and frequent respiratory toileting were also continuously performed or provided. Our patient was the first to receive PHV for flail chest at our hospital. To be cautious, we observed her adaptation in the ICU for about two weeks after applying PHV. In the future, the adaptation period of PHV can be shorter. In summary, we report a case of a patient with a flail chest after CPR. Her flail chest was successfully treated with a PHV and respiratory rehabilitation without any surgical treatment. We think that PHV is useful as an alternative treatment for patients with a flail chest after surgical fixation. Abbreviations CPR Cardio Pulmonary Resuscitation PHV Portable Home Ventilator MS Mitral Stenosis ICU Intensive Care Unit ETI Endo Tracheal Intubation Declarations Ethics approval and consent to participate The case is resented anonymously, and patient consent have been obtained for publication Consent for publication Verbal informed consent was obtained from the patient for publishing this case report and accompanying images. Availability of data and materials The dataset supporting the conclusions of this article is included within the article, and any other inquiry is available from the corresponding author on reasonable request Competing interests All authors declare that they have no competing interests relevant to this study. Funding This study received no funding. Authors’ contribution YL wrote the draft of the manuscript and obtained the written and verbal consent. TJ and DL performed the surgery and literlature review and helped to the final writing of the paper. All authors have read and approved the final manuscript. Acknowledgement None References el-Banayosy A, Brehm C, Kizner L, Hartmann D, Körtke H, Körner MM, Minami K, Reichelt W, Körfer R. Cardiopulmonary resuscitation after cardiac surgery: a two-year study. J Cardiothorac Vasc Anesth. 1998 Aug;12(4):390–2. Michaelis P, Leone RJ. Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol. Crit Care Nurse. 2019 Feb;39(1):15–25. Dunning J, Fabbri A, Kolh PH, Levine A, Lockowandt U, Mackay J, Pavie AJ, Strang T, Versteegh MI, Nashef SA, EACTS Clinical Guidelines Committee. Guideline for resuscitation in cardiac arrest after cardiac surgery. Eur J Cardiothorac Surg. 2009 Jul;36(1):3–28. Enarson DA, Didier EP, Gracey DR. Flail chest as a complication of cardiopulmonary resuscitation. Heart Lung. 1977 Nov-Dec;6(6):1020–2. Ananiadou O, Karaiskos T, Givissis P, Drossos G. Operative stabilization of skeletal chest injuries secondary to cardiopulmonary resuscitation in a cardiac surgical patient. Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):478–80. Perera TB, King KC. Flail C. 2021 Jan 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30475563. Claydon O, Benamore R, Belcher E. Outcomes of chest wall fixation in cardiopulmonary resuscitation-induced flail chest. Interact Cardiovasc Thorac Surg. 2020 Sep 1;31(3):417–418. Schuurmans J, Goslings JC, Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2017 Apr;43(2):163–8. Nishiumi N, Fujimori S, Katoh N, Iwasaki M, Inokuchi S, Inoue H. Treatment with internal pneumatic stabilization for anterior flail chest. Tokai J Exp Clin Med. 2007 Dec;20(4):126–30. 32(. Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995 Dec;110(6):1676–80. Schreiber A, Yıldırım F, Ferrari G, Antonelli A, Delis PB, Gündüz M, Karcz M, Papadakos P, Cosentini R, Dikmen Y, Esquinas AM. Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review. Turk J Anaesthesiol Reanim. 2018 Apr;46(2):88–95. Supplementary Files CAREchecklist.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-731108","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case report","associatedPublications":[],"authors":[{"id":46068254,"identity":"da5812da-b85c-41fd-9451-16df1e0c0708","order_by":0,"name":"Dong Hyup Lee","email":"","orcid":"","institution":"Yeungnam University Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dong","middleName":"Hyup","lastName":"Lee","suffix":""},{"id":46068255,"identity":"f7fb18fe-0bb6-4ba5-95fe-ecb7258dd07b","order_by":1,"name":"Young Uk Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYJCCAwwVEnL8JGo5Y2Ms2UCSHsa2tESDA8SqNm/vTjzwge1wgvHt5mcSH/cwyPOLEdAsc+bshoMzeA7nmd05ZiY54xmD4czZCfi1SEjkbjjMI3G42OxGgrExzwGGBIPbRGkxOJy4eUb6Z+M/xGtJSEvcIJFj+JiBKC08IL8csDGWuJFT+LDngAQRfmHv3fzh4z9gVM5I33DgxwEbeX5pAlowjCBN+SgYBaNgFIwC7AAA2VxH2WMPyRAAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-9593-4775","institution":"Yeungnam University Medical Center","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Young","middleName":"Uk","lastName":"Lee","suffix":""},{"id":46068256,"identity":"988a9402-19fd-4779-a302-7eea69ffacb1","order_by":2,"name":"Tae-Eun Jung","email":"","orcid":"","institution":"Yeungnam University Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tae-Eun","middleName":"","lastName":"Jung","suffix":""}],"badges":[],"createdAt":"2021-07-19 01:47:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-731108/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-731108/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":12502987,"identity":"c3beed58-87ee-4ecb-b317-ab34d64e39f7","added_by":"auto","created_at":"2021-08-17 15:09:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1846830,"visible":true,"origin":"","legend":"A, B: Computed tomography findings for chest wall reconstruction.\nImage showing multiple rib fractures at the anterior arch and costochondral junction (white arrow).\nC: 3D Chest wall reconstruction. Flail segment was not prominent in 3D chest wall reconstruction.\nD: Chest x-ray at the time of discharge","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-731108/v1/20bab1c79d056971fc81f8b4.png"},{"id":12502986,"identity":"e7a8bd3c-a466-49e9-9454-9570b20687d7","added_by":"auto","created_at":"2021-08-17 15:09:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":196755,"visible":true,"origin":"","legend":"Portable home ventilator. Trilogy 100 (Philips Respironics: United States). ","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-731108/v1/3e0de37f15fa70c0e031500f.png"},{"id":20428295,"identity":"f3023316-6e5c-4555-90de-3bd762a9d362","added_by":"auto","created_at":"2022-04-17 16:18:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1657463,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-731108/v1/7f4bd6fe-a550-4224-a82d-12369eefd889.pdf"},{"id":12502988,"identity":"9480dbc7-2aa0-42b5-8de2-eb6ddddc84fa","added_by":"auto","created_at":"2021-08-17 15:09:27","extension":"pdf","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":548295,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklist.pdf","url":"https://assets-eu.researchsquare.com/files/rs-731108/v1/cdd5d3ea4602db72a9b60f06.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eApplication of a Portable Home Ventilator for Treating Flail Chest After Cardiopulmonary Resuscitation: A Case Report\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe incidence of unexpected cardiopulmonary resuscitation (CPR) after cardiac surgery is about 0.7\u0026ndash;5.2%. It has reduced in recent years [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Skeletal chest injury after CPR can occur at a rate of 90%. The incidence of a flail chest after CPR is about 5% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A patient with a flail chest frequently patient requires long-term mechanical ventilator care. Application of a portable home ventilator (PHV) is one last major step when treating patients who require long-term mechanical ventilation. For patients with flail chest, early application of PHV is important. Here, we present a case of a patient with a flail chest successfully treated with PHV.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 61-year-old Asian female patient was referred to our department with dyspnea and palpitation. The patient had been diagnosed with mitral stenosis (MS) 20 years previously. She was on medication. Severe MS and mild tricuspid valve regurgitation were confirmed by echocardiography. Atrial fibrillation was also observed on electrocardiogram. Based on the above findings, the patient underwent mitral valve replacement, tricuspid valve annuloplasty, and mini-Maze. She was extubated and treated in a general ward. On the 12th postoperative day, the patient underwent pericardial window formation due to cardiac tamponade with large hematoma. Five days after the window operation, the patient had unexpected cardiac arrest and survived after 25 minutes of CPR. On the follow-up echocardiography, the replaced valve and cardiac function were normal. We attempted ventilator weaning and extubation twice. However, respiratory failure progressed due to a flail chest.\u003c/p\u003e \u003cp\u003eChest wall reconstruction computed tomography was then conducted to evaluate the flail chest and for surgical planning (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Right 3rd-7th and left 2nd-7th anterior arch of rib fractures and displaced sternum were observed. However, it was difficult to determine the surgical fixation site because the flail segment was not prominent and the fracture displacement was not severe (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). Considering her nutritional state and previous two surgeries under general anesthesia, we decided to continue internal fixation with ventilator care.\u003c/p\u003e \u003cp\u003eTracheostomy was performed on the 19th day after CPR. After about 2 weeks of ventilator weaning, PHV was applied (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and the patient started respiratory rehabilitation including intermittent positive pressure ventilation, coughing machine, and diaphragmatic respiration. The patient was transferred to a general ward at 3 weeks after PHV application. On transfer to the general ward, the following settings were used: synchronized intermittent mandatory ventilation mode, O2 flow rate at 2 liter/minute, respiration rate of 8, and tidal volume of 350 ml.\u003c/p\u003e\u003cp\u003ePHV support and lung rehabilitation were continued for another three weeks. After chest wall stabilization and self-sputum toileting were confirmed, PHV weaning was done and the tracheostomy site was sealed off. Subsequently, the patient was discharged without any specific findings (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). She has been followed up at an outpatient clinic for three years. Currently, the patient activity is New York Heart Association classification I\u0026thinsp;~\u0026thinsp;II without any specific problems.\u003c/p\u003e"},{"header":"Disccussion And Conclusion","content":"\u003cp\u003eFlail chest is caused by paradoxical movement of a flail segment caused by intrathoracic negative pressure. It can increase respiratory effort and cause atelectasis, eventually enhancing mortality and complication rates [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Management of flail chest includes maintenance of adequate ventilation, fluid and pain management, and stabilization of the chest wall. Typically, treatment of an unstable chest wall involves internal stabilization using a ventilator or surgical fixation of the flail segment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Both methods have their advantages and disadvantages. Recent studies have reported that surgical treatment produces better results in terms of pneumonia incidence, intensive care unit (ICU) and hospital stays, lung function, and cost than the use of a ventilator [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, surgical treatment has the disadvantage of exposing patients to surgical stress comparable to that caused by a traumatic event [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, rib fractures after CPR tend to be underestimated by imaging, which can make it difficult to locate the prominent flail segment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, as seen in our case, general anesthesia and surgical treatment might be difficult for cardiac surgery patients due to hemodynamic instability, anticoagulant use, or previous sternotomy. In patients who have difficulties after surgical treatment, the use of PHV might be a good alternative. Home ventilators are relatively easy to operate and portable. They can be applied in general wards. Early hospital application of PHV and general ward transfer have both short-term and long-terms benefits. In a short term, PHV protects patients from severe ICU infections, reduces delirium, and facilitates treatment by increasing the range of rehabilitation treatments that can be applied. For patients requiring long-term ventilator care due to COPD, neuromuscular disease, skeletal disorder, or permanent damage to lung function due to trauma, in-hospital application of PHV can provide a useful adaptation period for patients and caregivers.\u003c/p\u003e \u003cp\u003eRecently, the use of noninvasive mechanical ventilation to avoid endotracheal intubation (ETI) has increased in the treatment of flail chest. Even if ETI and mechanical ventilation have been started, mechanical ventilation should be discontinued as soon as possible [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe importance of conservative treatment with rehabilitation and bedside treatment should not be overlooked. In the described case, respiratory rehabilitation was performed continuously, including intermittent positive pressure ventilation, coughing machine application, and diaphragmatic respiration. Bedside treatments such as manual percussion, encouraging ambulation, emotional support, and frequent respiratory toileting were also continuously performed or provided. Our patient was the first to receive PHV for flail chest at our hospital. To be cautious, we observed her adaptation in the ICU for about two weeks after applying PHV. In the future, the adaptation period of PHV can be shorter.\u003c/p\u003e \u003cp\u003eIn summary, we report a case of a patient with a flail chest after CPR. Her flail chest was successfully treated with a PHV and respiratory rehabilitation without any surgical treatment. We think that PHV is useful as an alternative treatment for patients with a flail chest after surgical fixation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardio Pulmonary Resuscitation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePortable Home Ventilator\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMitral Stenosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eETI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndo Tracheal Intubation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case is resented anonymously, and patient consent have been obtained for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal informed consent was obtained from the patient for publishing this case report and accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is included within the article, and any other inquiry is available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests relevant to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYL wrote the draft of the manuscript and obtained the written and verbal consent. TJ and DL performed the surgery and literlature review and helped to the final writing of the paper. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eel-Banayosy A, Brehm C, Kizner L, Hartmann D, K\u0026ouml;rtke H, K\u0026ouml;rner MM, Minami K, Reichelt W, K\u0026ouml;rfer R. Cardiopulmonary resuscitation after cardiac surgery: a two-year study. J Cardiothorac Vasc Anesth. 1998 Aug;12(4):390\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichaelis P, Leone RJ. Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol. Crit Care Nurse. 2019 Feb;39(1):15\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunning J, Fabbri A, Kolh PH, Levine A, Lockowandt U, Mackay J, Pavie AJ, Strang T, Versteegh MI, Nashef SA, EACTS Clinical Guidelines Committee. Guideline for resuscitation in cardiac arrest after cardiac surgery. Eur J Cardiothorac Surg. 2009 Jul;36(1):3\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEnarson DA, Didier EP, Gracey DR. Flail chest as a complication of cardiopulmonary resuscitation. Heart Lung. 1977 Nov-Dec;6(6):1020\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnaniadou O, Karaiskos T, Givissis P, Drossos G. Operative stabilization of skeletal chest injuries secondary to cardiopulmonary resuscitation in a cardiac surgical patient. Interact Cardiovasc Thorac Surg. 2010 Mar;10(3):478\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerera TB, King KC. Flail C. 2021 Jan 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan\u0026ndash;. PMID: 30475563.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClaydon O, Benamore R, Belcher E. Outcomes of chest wall fixation in cardiopulmonary resuscitation-induced flail chest. Interact Cardiovasc Thorac Surg. 2020 Sep 1;31(3):417\u0026ndash;418.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchuurmans J, Goslings JC, Schepers T. Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review. Eur J Trauma Emerg Surg. 2017 Apr;43(2):163\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishiumi N, Fujimori S, Katoh N, Iwasaki M, Inokuchi S, Inoue H. Treatment with internal pneumatic stabilization for anterior flail chest. Tokai J Exp Clin Med. 2007 Dec;20(4):126\u0026ndash;30. 32(.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995 Dec;110(6):1676\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchreiber A, Yıldırım F, Ferrari G, Antonelli A, Delis PB, G\u0026uuml;nd\u0026uuml;z M, Karcz M, Papadakos P, Cosentini R, Dikmen Y, Esquinas AM. Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review. Turk J Anaesthesiol Reanim. 2018 Apr;46(2):88\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Flail chest, Cardiopulmonary resuscitation, Portable ventilator","lastPublishedDoi":"10.21203/rs.3.rs-731108/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-731108/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eUnexpected cardiopulmonary resuscitation and subsequent flail chest are rare in cardiac surgery patients. A patient with a flail chest frequently requires long-term mechanical ventilator care.\u0026nbsp;Early application of portable home ventilator (PHV) might be a useful treatment. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA 61-year-old female who underwent cardiac surgery had unexpected cardiopulmonary resuscitation with a flail chest. For treating her flail chest, portable home ventilator was applied with several respiratory rehabilitations. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe think PHV is useful and alternative treatment for inappropriate for surgical fixation in flail chest patients.\u003c/p\u003e","manuscriptTitle":"Application of a Portable Home Ventilator for Treating Flail Chest After Cardiopulmonary Resuscitation: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-08-17 15:09:25","doi":"10.21203/rs.3.rs-731108/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"586cfb53-4d7c-4c59-818e-15860df1ce13","owner":[],"postedDate":"August 17th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":6499860,"name":"Cardiac \u0026 Cardiovascular Systems"},{"id":6499861,"name":"Cardiothoracic Surgery"}],"tags":[],"updatedAt":"2022-04-17T16:18:06+00:00","versionOfRecord":[],"versionCreatedAt":"2021-08-17 15:09:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-731108","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-731108","identity":"rs-731108","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}