Hi all,

Has anyone cared for a patient with multiple unilateral missing ribs? I have a patient missing multiple ribs on the right side. Very low vent settings but failed extubation due to work of breathing.

If you have experience with this has any surgical team tried a temporary rib cage intervention (metal insert) in attempt to avoid a tracheostomy? Or have you pursued tracheostomy to defer intervention for later in life?

CXR

Tricky case, I have no experience… How high CPAP did you extubate to? If work of breathing is low, did you try HFOV and see how low CDP you can use? Guess stability and lung mechanics will improve with time, ie you “just” need a shorter term solution?

Given the rarity of this condition, clinical experience is limited. In this patient, the primary issue appears to be chest wall instability, resulting in increased work of breathing despite minimal ventilatory requirements. A variable degree of pulmonary hypoplasia may also be contributing to the clinical picture.

I am not aware of temporary rib cage prostheses being used acutely solely to facilitate extubation. Chest wall reconstruction has been described, but as part of a long-term structural strategy rather than a short-term bridge.

When optimized noninvasive respiratory support fails to adequately reduce work of breathing, tracheostomy becomes necessary to allow for growth and stabilization before pursuing definitive reconstruction.

Hi currently facing a similar case in my hospital . Wondering if we could get a titanium cage

@westerngreen how are things progressing for your unusual case? Would be interesting to learn from it!

Thank you for checking in. The infant extubated to CPAP but has not weaned off positive pressure due to WOB and tachypnea with paradoxical movement of that chest wall segment. Discussing potential interventions with family and surgical team now...