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Management of lung contusion.

B Shin, T C McAslan, J R Hankins

    The American Surgeon
    |March 1, 1979
    PubMed
    Summary
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    Early mechanical ventilation with positive end-expiratory pressure for lung contusion patients effectively prevented hypoxemia and pulmonary deterioration, with a low incidence of complications and mortality.

    Area of Science:

    • Pulmonology
    • Critical Care Medicine
    • Trauma Surgery

    Background:

    • Lung contusion is a significant injury following blunt chest trauma.
    • Interstitial edema and intra-alveolar hemorrhage can lead to hypoxemia and respiratory failure.
    • Early intervention is crucial for managing severe lung contusions.

    Purpose of the Study:

    • To evaluate the efficacy of early intubation and mechanical ventilation with positive end-expiratory pressure (PEEP) in patients with lung contusion.
    • To assess the impact of this management strategy on preventing hypoxemia and pulmonary deterioration.
    • To determine the incidence of complications and overall mortality in this patient cohort.

    Main Methods:

    • A retrospective study of 132 consecutive patients with lung contusion admitted between 1972 and 1974.

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  • All patients received early intubation and mechanical ventilation with PEEP.
  • Extubation criteria included absence of progressive alveolar/arterial oxygen tension gradient increase and no other non-thoracic indications for ventilation.

    • Main Results:

    • Mean ventilation time was 6.2 days.
    • Progressive hypoxemia and deterioration of pulmonary function were not observed.
    • Low incidence of pneumonia (1.5%) and tension pneumothorax (0.75%).
    • Overall mortality was 10.6%, with brain death being the most common cause.
    • No deaths were attributed to hypoxemia.

    Conclusions:

    • Early mechanical ventilation with PEEP is an effective strategy for managing lung contusion.
    • This approach minimizes the risk of hypoxemia and pulmonary complications.
    • The management protocol demonstrated a low incidence of adverse events and mortality related to respiratory failure.