ICU management of blunt chest trauma: our experience

Blunt chest tramma is a major cause of mortality and morbidity following road side accident. An understanding of the factors affecting the mortality and morbidity will help in formulating better management strategies. The records of 40 consecutive patients presenting with blunt chest trauma (BCT) requiring ICU care from 1994-1996 were reviewed. Flail chest was the most common chest injury seen in 35 patients (87.5%). Isolated flail chest was seen in 22 patients, isolated pulmonary contusion in 2 patients and a combined injury in 13 patients. Ventilatory assistance was required in 34 patients (85%) for an average duration of 16 days (range 2-43 days). All patients with anterior flail required assisted ventilation in contrast to 75% and 88% of patients with unilateral and bilateral flail respectively. Presence of pulmonary contusion with or without flail was also associated with a high incidence of ventilatory support requirement. Chest infection (pneumonia) was the most common complication seen (65%). Adverse outcome occurred in 12 patients (30%). The main contributing factors for increased morbidity and mortality were: associated pulmonary contusion, associated extrathoracic injuries and preexisting medical illness. Statistical significance was observed only with pulmonary contusion.