Pulmonary disability after severe blunt chest trauma

Twenty-eight patients surviving severe chest injury were studied prospectively (Group I) to assess the timing of recovery and the degree of residual pulmonary dysfunction. Pulmonary function tests (PFT) were obtained within 2 weeks of discharge and serially at intervals of 3 to 6 months. In addition, 16 patients injured 1 to 11 years previously (mean, 33 months) were recalled to determine long-term respiratory disability (Group II). Standard spirometric pulmonary function measurements were obtained. The mean age (36 yrs) and ISS (34) were the same in both groups. The majority of patients required intubation and mechanical ventilation, averaging 21 days in Group I and 18 days in Group II. PFTs were markedly abnormal soon after injury, averaging 40 to 50% of predicted values for all tests performed. Rapid improvement in all parameters was noted by 4 months after discharge and pulmonary function had almost returned to normal by the last followup exam (average, 65 to 90% of predicted). Results in Group II demonstrated continued improvement over long periods of followup. All patients who were employed preinjury had returned to work by 6 months after discharge except one. Long-term respiratory disability was present in less than 5% of patients studied. We conclude that recovery from severe chest injury occurs rapidly in most patients and serious long-term respiratory disability is uncommon. These results justify the commitment of major resources to the intensive care of patients with severe chest injuries.