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Unilateral diaphragmatic dysfunction in blunt chest trauma.
H Gastinne1, J Venot, J P Dupuy
1Department of Intensive Care Medicine, Dupuytren Academic Hospital, Limoges, France.
Chest
|March 1, 1988
Summary
Blunt chest trauma can cause unilateral diaphragmatic dysfunction, reducing diaphragm displacement and breathing contribution. This dysfunction, particularly after lower chest injuries, may lead to respiratory failure.
Area of Science:
- Pulmonology
- Trauma Surgery
- Radiology
Background:
- Unilateral diaphragmatic dysfunction is a potential complication following blunt chest trauma.
- Assessing diaphragmatic function is crucial for managing respiratory compromise in trauma patients.
Purpose of the Study:
- To evaluate unilateral diaphragmatic dysfunction within ten days after blunt chest trauma.
- To correlate diaphragmatic dysfunction with injury location and severity.
Main Methods:
- Thirty patients with unilateral chest injuries were studied in a supine position under analgesia.
- Digital subtraction radiography measured right and left hemidiaphragm displacement (DD) during quiet and forced breathing.
- Diaphragmatic contribution to breathing was assessed via rib cage and abdominal circumference changes.
Main Results:
- Diaphragm displacement (DD) on the injured side was significantly lower than on the uninjured side (p<0.01, p<0.001).
- Six patients exhibited complete diaphragmatic motionlessness.
- Inspired air volume due to diaphragmatic motion (Vab) was reduced, with Vab/VT ratio consistently below 0.65.
Conclusions:
- Diaphragmatic dysfunction is common after blunt chest trauma and is more severe with lower chest injuries, suggesting direct diaphragm involvement.
- Reduced diaphragmatic function can contribute to respiratory failure in these patients.
- Diaphragmatic dysfunction should be considered in the clinical evaluation of patients with blunt chest trauma.