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[Contusion of the lungs in childhood]
1Klinika dĕtské chirurgie 2. LF UK, FN Motol, Praha.
Insights
Pediatric lung contusion, often part of severe multiple injuries, requires intensive care including ventilation and thoracic drainage. Mortality in these cases is primarily linked to severe central nervous system injuries.
Area of Science:
- Pediatric Traumatology
- Thoracic Surgery
- Critical Care Medicine
Context:
- Lung contusion in children is frequently associated with polytrauma.
- Management varies based on injury severity and vital function status.
- Diagnosis relies on clinical, radiological, and laboratory findings.
Purpose:
- To analyze the clinical characteristics, management, and outcomes of pediatric lung contusion.
- To identify factors associated with morbidity and mortality in this patient group.
Summary:
- A retrospective study reviewed 45 pediatric patients (1-15 years) with lung contusion.
- Most cases (38/45) involved multiple injuries and compromised vital functions, necessitating intensive care.
- Common associated injuries included severe craniocerebral trauma (71%), abdominal/retroperitoneal injuries (37.8%), long bone fractures (42%), and rib fractures (46.6%).
- Treatment involved endotracheal intubation and mechanical ventilation in 35 patients, antibiotics (98%), steroids (84%), and thoracic drainage (40%).
- Mortality was 13.3% (6/45), with severe central nervous system injuries being the primary cause of death.
Impact:
- Highlights the significant morbidity associated with pediatric lung contusion and polytrauma.
- Underscores the critical role of intensive care and supportive measures.
- Identifies severe CNS injury as a key determinant of mortality in pediatric lung contusion.
Abstract:
The authors evaluated in a retrospective study a group of 45 patients with contusion of the lungs (age 1 to 15 years) who were treated at the Faculty Hospital in Motol in 1989-1993. In 38 children contusion of the lungs was part of multiple injuries with signs of failure of vital functions. These children were admitted after the injury to the in-patient department of the Anaesthesiological and Resuscitation Clinic. Seven children without alterations of vital functions were treated at the Department of Paediatric Surgery. The diagnosis was based on the case-history, clinical examination, X-ray examination and laboratory signs of lung injuries. An isolated pneumothorax was found in 17.8% of the injured children, haemothorax in 8.9% and in 24.5% pneumothorax and haemothorax. Severe craniocerebral injuries were diagnosed in 71% of patients, 37.8% children had concomitant injuries of the abdominal organs and retroperitoneum and 42% had fractures of the long bones. 46.6% of the children had rib fractures. The condition of 35 injured children called for endotracheal intubation (on average for 17 days) and artificial ventilation (on average for 14.4 days). 98% of the injured children were given antibiotics, in 84% steroids were administered, in 18 of the injured children (40%) drainage of the thoracic cavity was essential. Six patients (13.3%) drainage of the thoracic cavity was essential. Six patients (13.3%) died--the cause of death were severe injuries of the CNS.