Outcome in patients with blunt chest trauma and pulmonary contusions

ABSTRACT: Severe pulmonary contusions occur in blunt chest trauma, especially with high velocity injuries. Pulmonary contusions following trauma may result in significant hypoxemia and decreased compliance which may progress over several days. Extensive contusions may result in respiratory difficulty or progress to adult respiratory distress syndrome, which increases mortality. We decided to review the cases of polytrauma with associated pulmonary contusions to determine the factors which influence outcome.
MATERIALS AND METHODS: A retrospective chart review of all cases of trauma with pulmonary contusions on X-ray or CT scan. The cases were examined for age, type of injuries, admission APACHE II, SAPS II and SOFA scores, PaO₂/FiO₂ ratio, presence or absence of rib fractures, average positive fluid balance, average sedation dose, pulmonary haemorrhage, ventilator days, ICU days and hospital outcome.
RESULTS: There were 18 cases of pulmonary contusions. All had associated injuries. 6 patients died, 4 in the ICU and 2 patients died 1 week after transfer to a high dependency unit, one due to sepsis and the other due to massive haemothorax. There was a significant difference in PaO₂/FiO₂ ratio at admission and throughout the ICU course, fluid balance and sedation dose, but not in ventilator days and ICU days between survivors and nonsurvivors. The incidence, frequency and amount of pulmonary haemorrhage were higher in the nonsurvivors.
CONCLUSIONS: Close attention to improving gas exchange, and early management of hemoptysis might improve outcome in pulmonary contusions

Keywords
Chest trauma, pulmonary contusion, fluid balance, hemoptysis, rib fractures.