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Pulmonary and respiratory complications of pediatric trauma
1Department of Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
Insights
Pediatric trauma care involves surgery and supportive measures, with complications possible at all stages. Effective management of pediatric trauma requires rapid, organized interventions to improve survival and reduce long-term illness.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Critical Care
Background:
- Pediatric trauma management necessitates both operative and nonoperative (supportive) care strategies.
- Fewer than 15% of pediatric trauma patients require surgery, with closed head injury and multisystem trauma being primary concerns.
- Complications can arise from fluid resuscitation, delayed antibiotics, inadequate pain control, and mechanical ventilation.
Purpose of the Study:
- To highlight the complexities and potential complications in pediatric trauma management.
- To emphasize the importance of organized systems and prompt interventions in improving outcomes.
- To discuss the evolving landscape of pediatric trauma due to increased injury severity.
Main Methods:
- Review of pediatric trauma management principles, including operative and nonoperative care.
- Analysis of potential complications associated with various interventions like mechanical ventilation, minor procedures (thoracentesis, chest tube insertion), and major surgeries (laparotomy, thoracotomy).
- Discussion of risks related to transfusion, cardiopulmonary bypass, invasive monitoring, and prolonged resuscitation.
Main Results:
- Complications can occur at all levels of care, from initial resuscitation to major surgical interventions.
- Risks include hemorrhage, organ injury, infection, coagulopathy, hypothermia, and ventilator-induced lung injury.
- Despite complexities, rapid evacuation, prompt resuscitation, and organized systems have reduced pediatric trauma mortality.
Conclusions:
- Effective pediatric trauma care demands meticulous attention to detail at every step to mitigate risks.
- Identifying and managing complications proactively is crucial for improving survival rates and reducing long-term morbidity.
- Advancements in diagnostic and therapeutic modalities are essential for addressing the increasing severity of pediatric trauma cases.
Abstract:
Pediatric trauma management requires both operative and nonoperative (supportive) care. Fewer than 15% of pediatric trauma patients require surgery (Children's Hospital of Michigan Registry Data, excluding fractures), and the primacy of closed head injury and the multisystem nature of pediatric trauma dictate assessment and therapy. Complications arise at every level, including fluid resuscitation (too much or too little), antibiotics (too late), or pain control (inadequate). The institution of mechanical ventilation that is usually life-saving carries its own risks including those associated with intubation (perforation, aspiration, pro longed endotracheal intubation (stricture, pneumonia), and barotrauma (ventilator-induced lung injury). Minor procedures, such as thoracentesis, chest tube insertion, and pericardiocentesis, can all be complicated by perforation and hemorrhage. Major interventions, including laparotomy and thoracotomy, can result in hemorrhage, air leak, abdominal compartment syndrome, phrenic nerve and thoracic duct injury, postoperative abscess, and septicemia. Transfusion, cardiopulmonary bypass, and invasive monitoring can result in coagulopathy and vascular injury. Prolonged resuscitation and operative explorations can cause hypothermia and coagulopathy and initiate a cascade of multiorgan failure and ARDS. There is no doubt that rapid evacuation, prompt resuscitation, and organized systems of pediatric trauma care have reduced the overall mortality of childhood trauma. The higher velocity of travel and an increasingly chaotic urban environment have resulted in more multitrauma cases and in injuries of higher severity requiring more sophisticated and complicated diagnostic and therapeutic modalities. Our ability to identify life-threatening injuries, to provide expedited and definitive care, and to reduce and detect the complications predicted by these injuries and their treatment will result in long-term improvements in survival and significant reductions in morbidity.