Management of major thoracic trauma: a narrative review

Traumatic thoracic injuries are a leading cause of morbidity and mortality worldwide, not only as a direct consequence of the injury itself, but also due to development of secondary insults such as infection; acute kidney injury; acute respiratory distress syndrome; and shock. The thorax houses vital structures, and even seemingly trivial trauma may result in catastrophic damage particularly in children or older patients. This review aims to highlight important considerations in diagnosis and management of major thoracic injuries and the crucial role of appropriate supportive interventions such as airway control, ventilation strategies and optimal pain management to aid in recovery.

We undertook a narrative review of the contemporary literature. We synthesised evidence related to mechanisms of thoracic trauma and initial assessment and diagnosis of major thoracic injuries. We also highlight key considerations in chest wall, pulmonary, cardiac and diaphragmatic injuries; supportive management strategies for patients with thoracic trauma; and special considerations in older patients.

Thoracic injuries are broadly classified by the mechanism of trauma (blunt, penetrating or blast) or by the anatomical structure involved. Initial assessment and diagnosis follows general trauma principles. Depending on the injuries sustained, surgical intervention may be indicated. Equally important is appropriate supportive management. Older patients are often overlooked as a high-risk group and a lower threshold for specialised trauma care or critical care services is recommended in this cohort.

A multidisciplinary approach is key in management of patients with thoracic trauma due to their numerous needs, ranging from surgical intervention and critical care support to physiotherapy and rehabilitation.