Ventilatory support of the trauma patient with pulmonary contusion

Pulmonary contusion is a common clinical condition seen in patients with thoracic trauma. The mortality rate from isolated pulmonary contusion is low, but when combined with other severe injuries patients with pulmonary contusion can have mortality rates as high as 10% to 57%. Early aggressive mechanical ventilatory support can prevent progressive atelectasis and worsening of arterial oxygenation. Careful titration of ventilatory support to physiologic end points is a reasonable approach. Unfortunately, data comparing the means of achieving the end points are lacking and no published prospective, randomized trials demonstrate superiority of any particular mode of support. Careful attention to detail and physiologic management of the patient in a goal-directed fashion using a multidisciplinary team approach involving the respiratory care practitioner, nurse, and physician is the current state of the art in the management of patients with pulmonary contusion.