Crystalloid resuscitation of patients with pulmonary contusion

One hundred nine patients with the diagnosis of pulmonary contusion were studied retrospectively. Thirteen deaths were respiratory related (12 percent of patients). All of the patients were quickly resuscitated with crystalloid solutions as necessary to restore perfusion to normal. Twenty-eight of the most severely injured patients, all of whom were intubated and ventilated and in whom serial PaO2 and total protein determinations were available, were examined for the relationship between crystalloid induced hemodilution as measured by the plasma colloid oncotic pressure and oxygenation as measured by the PaO2/FiO2 ratio. When survivors and nonsurvivors were analyzed by group, both individually and collectively, no correlation was found between oxygenation and oncotic pressure. Survivors and nonsurvivors exhibited similar post-traumatic courses in the PaO2/FiO2 ratios with differences not becoming significant until the eleventh day after injury. We conclude that contusion is not a progressive lesion unless pneumonia supervenes and that pulmonary dysfunction after contusion is unrelated to hemodilution.