Which ventilation strategy is used to manage flail chest after securing the airway?

• A. Positive end-expiratory pressure (PEEP)
• B. Randomized tidal volume reduction
• C. Noninvasive ventilation only
• D. No mechanical ventilation needed

Answer: (A)

Flail chest requires both securing the airway and stabilizing the chest wall to improve ventilation. Positive end-expiratory pressure provides a continuous positive pressure that keeps alveoli open, improves oxygenation, and acts as an internal splint to reduce the paradoxical inward movement of the flail segment during inspiration. This stabilization, achieved during mechanical ventilation, directly supports gas exchange and decreases the work of breathing while the chest heals. Other options don’t provide the same chest-wall stabilization and oxygenation benefits: lowering tidal volume alone isn’t a targeted strategy for flail chest, noninvasive ventilation is usually insufficient after airway management in significant flail chest, and skipping mechanical ventilation ignores the need to control movement of the injured segment.