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Pulmonary contusion in severe head trauma patients: impact on gas exchange and outcome

Marc Leone1, Jacques Albanèse, Sébastien Rousseau

  • 1Intensive Care Unit and Trauma Center, Department of Biostatistics, Nord Hospital, AP-HM, Marseilles University Hospital System, School of Medicine, 13915 Marseilles cedex, France. marc.leone@ap-hm.fr

Chest
|December 11, 2003
PubMed
Abstract

Insights

Pulmonary contusion in severe head trauma patients impairs gas exchange but does not increase morbidity or mortality. Further research is needed due to potential sample-size limitations.

Area of Science:

  • Trauma Surgery
  • Critical Care Medicine
  • Pulmonary Medicine

Background:

  • Severe head trauma is a common injury in multiple-trauma patients.
  • Pulmonary contusion is a frequent associated injury.
  • The impact of pulmonary contusion on outcomes in this patient population requires further clarification.

Purpose of the Study:

  • To evaluate the impact of pulmonary contusion on morbidity and mortality in multiple-trauma patients with severe head trauma.
  • To determine if pulmonary contusion affects gas exchange, ICU length of stay, complication rates, or mortality.

Main Methods:

  • Matched-paired, case-control study of 313 multiple-trauma patients with severe head trauma (Glasgow Coma Scale ≤ 8).
  • 90 patients with pulmonary contusion (diagnosed via clinical context and CT scan) were matched with 90 control patients.
  • Matching criteria included age, sex, GCS, injury pattern, and SAPS II score.

Main Results:

  • Pulmonary contusion significantly reduced the PaO(2)/FiO(2) ratio, indicating impaired gas exchange.
  • No significant differences were observed in ICU stay, nosocomial pneumonia, ARDS, Glasgow Outcome Scale, or mortality rates between patients with and without pulmonary contusion.
  • Mortality remained unaffected even when stratified by the severity of the PaO(2)/FiO(2) ratio.

Conclusions:

  • In this cohort, pulmonary contusion alters gas exchange but does not increase morbidity or mortality in multiple-trauma patients with severe head trauma.
  • A potential sample-size effect may limit the generalizability of these findings.

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