Selective exclusion of the injured lung

Intratracheal bleeding and intrapleural air leakage that are uncontrollable by conventional therapy are life-threatening in patients with blunt pulmonary trauma. Selective exclusion of the injured lung is the most effective treatment in such cases. Two hundred six consecutive patients over a 5-year period with blunt pulmonary trauma who survived 5 hours or more after arriving at the hospital were divided into three categories based on mode of treatment. In 190 (92%), intratracheal bleeding, intrapleural air leakage, and intrapleural bleeding were controllable by conventional treatment (class 1). In six (3%), intratracheal bleeding and intrapleural air leakage were controllable by selective pulmonary exclusion, and intrapleural bleeding was controllable by tube thoracostomy (class 2). In ten (5%), thoracotomy was required because of uncontrollable intratracheal bleeding or intrapleural air leakage, despite selective pulmonary exclusion, or intrapleural hemorrhage was not controllable by tube thoracostomy (class 3). Among the 16 patients with class 2 or 3 trauma, 14 survived.