Mechanical ventilation and flail chest

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Dear list members,

do you use a specific mechanical ventilation strategy for patient with  
flail chest and underlying lung contusions, besides the lung  
protective approach for patient with ALI/ARDS? For example, Moore's  
Trauma textbook advocates the use of volume controlled over pressure- 
supported mode, the rationale being that even the modest negative  
pressures needed to trigger the ventilator cycle may destabilize the  
chest wall.

Thank you for your input.

Matthieu Gensburger

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