The management of 130 consecutive patients who suffered respiratory failure following chest injuries is described. Ninety-two patients required artificial ventilation. Associated injuries to the abdomen, the head, or the skeletal system were common and one-third suffered from pre-existing disease of the chest or other systems. In patients with respiratory failure but not requiring artificial ventilation, analgesia was provided by means of epidural injection of local anaesthetic, intercostal blocks or injection of morphine. In the artificially ventilated group continuous intravenous infusion of an analgesic, usually phenoperidine, was given. Laparotomy was performed in 38 patients of the series. Twenty-two of the ventilated patients died, 9 from cerebral injury and 5 from respiratory causes. Two of the non-ventilated group died. No long-term complications of tracheostomy were encountered in the 96 patients so managed in this series.