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Lung Contusion Management: Invasive and Noninvasive

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Abstract

Lung contusion (or pulmonary contusion) is common in patients who have sustained blunt chest trauma. Lung contusion consists of pulmonary parenchymal abnormalities related to pulmonary tissue injury resulting in hemorrhage, edema, and inflammation. Diagnosis is confirmed by chest radiograph and thoracic CT scan imaging. The sequelae of the lung contusion pulmonary parenchymal abnormalities include pneumonia, acute respiratory insufficiency and failure with hypoxemia and/or hypercarbia, and acute respiratory distress syndrome which is associated with significant morbidity and mortality. Treatment of lung contusion is initially supportive care, adequate pain control, fluid restrictive strategy, and pulmonary toilet with optimization of oxygenation and ventilation. Management of the complications associated with lung contusion may include drainage of associated hemothorax, noninvasive vs. invasive mechanical ventilation, VATS, and rib fracture fixation. For ARDS due to lung contusion, all advanced ARDS treatment strategies (low tidal volume ventilation, restrictive fluid strategy, neuromuscular blockade, prone position, inhaled nitric oxide, and extracorporeal membrane oxygenation) will be considered.

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References

  1. Fallon M. Lung injury in the intact thorax with report of a case. Br J Surg. 1940;28:39–49.

    Article  Google Scholar 

  2. Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg. 2004;41(3):211–380.

    Article  PubMed  Google Scholar 

  3. Alfano GS, Hale HW Jr. Pulmonary contusion. J Trauma. 1965;5(5):647–58. PMID: 5826710

    Article  CAS  PubMed  Google Scholar 

  4. Demuth WE Jr, Smith JM. Pulmonary contusion. Am J Surg. 1965;109:819–23. PMID: 14283348

    Article  PubMed  Google Scholar 

  5. Stevens E, Templeton AW. Traumatic nonpenetrating lung contusion. Radiology. 1965;85:247–52.

    Article  CAS  PubMed  Google Scholar 

  6. Lloyd JW, Smith AC, O’Connor BT. Classification of chest injuries as an aid to treatment. Br Med J. 1965;1(5449):1518–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Probst C, Pape H-C, Hildebrand F, Regel G, Mahlke L, Giannoudis P, et al. 30 years of polytrauma care: an analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury. 2009;40:77–83.

    Article  PubMed  Google Scholar 

  8. Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006;130(2):533–8. http://5minsono.com/lung-bruise/

    Article  PubMed  Google Scholar 

  9. http://5minsono.com/lung-bruise/; accessed 11/20/2017.

  10. Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014;12:25.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43(3):405–11. discussion 411-2

    Article  CAS  PubMed  Google Scholar 

  12. Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg. 2001;67(7):660–4.

    PubMed  CAS  Google Scholar 

  13. Lang P, Kulla M, Kerwagen F, Lefering R, Friemert B, Palm HG, TraumaRegister DGU. The role of whole-body computed tomography in the diagnosis of thoracic injuries in severely injured patients - a retrospective multi-Centre study based on the trauma registry of the German trauma society (TraumaRegister DGU®). Scand J Trauma Resusc Emerg Med. 2017;25(1):82. https://doi.org/10.1186/s13049-017-0427-4.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rodriguez RM, Friedman B, Langdorf MI, Baumann BM, Nishijima DK, Hendey GW, Medak AJ, Raja AS, Mower WR. Pulmonary contusion in the pan-scan era. Injury. 2016;47(5):1031–4. https://doi.org/10.1016/j.injury.2015.11.043. Epub 2015 Nov 30

    Article  PubMed  Google Scholar 

  15. Cohn SM, Dubose JJ. Pulmonary contusion: an update on recent advances in clinical management. World J Surg. 2010;34(8):1959–70. https://doi.org/10.1007/s00268-010-0599-9.

    Article  PubMed  Google Scholar 

  16. Ni YN, Luo J, Yu H, Liu D, Ni Z, Cheng J, Liang BM, Liang ZA. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: a systematic review and meta-analysis. Chest. 2017;151(4):764–75.

    Article  PubMed  Google Scholar 

  17. Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T 3rd, Rodriguez A, Smith L, Eastern Association for the Surgery of Trauma. Management of pulmonary contusion and flail chest: an eastern Association for the Surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351–61.

    Article  PubMed  Google Scholar 

  18. Brasel KJ, Moore EE, Albrecht RA, de Moya M, Schreiber M, Karm-Jones R, Rowell S, Namias N, Cohen M, Shatz DV, Biffl WL. Western trauma association critical decisions in trauma: management of rib fractures. WTA 2016 algorithm. J Trauma Acute Care Surg. 2017;82:200–3.

    Article  PubMed  Google Scholar 

  19. Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox A, Alley DE, Ditillo M, et al. Pain management for blunt thoracic trauma: a joint practice management guideline from the eastern Association for the Surgery of trauma and trauma anesthesiology society. J Trauma Acute Care Surg. 2016;81:936–51.

    Article  PubMed  Google Scholar 

  20. Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surgery & Acute Care Open. 2017;2:1–7.

    Article  Google Scholar 

  21. Koppurapu V, Meena N. A review of the management of complex Para-pneumonic effusion in adults. J Thorac Dis. 2017;9(7):2135–41.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bauman ZM, Kulvatunyou N, Joseph B, Jain A, Friese RS, Gries L, O'Keeffe T, Tang AL, Vercruysse G, Rhee P. A prospective study of 7-year experience using percutaneous 14-French pigtail catheters for traumatic hemothorax/Hemopneumothorax at a Level-1 trauma center: size still does not matter. World J Surg. 2017. https://doi.org/10.1007/s00268-017-4168-3. [Epub ahead of print]

  23. de Moya MA, Manolakaki D, Chang Y, Amygdalos I, Gao F, Alam HB, Velmahos GC. Blunt pulmonary contusion: admission computed tomography scan predicts mechanical ventilation. J Trauma. 2011;71(6):1543–7.

    PubMed  Google Scholar 

  24. Daurat A, Millet I, Roustan JP, Maury C, Taourel P, Jaber S, Capdevila X, Charbit J. Thoracic trauma severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 2016;47(1):147–53. https://doi.org/10.1016/j.injury.2015.08.031. PMID: 26358517

    Article  PubMed  Google Scholar 

  25. Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL, Fabian TC. ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma. 2001;51(2):223–8. discussion 229-30

    Article  CAS  PubMed  Google Scholar 

  26. Mahmood I, El-Menyar A, Younis B, Ahmed K, Nabir S, Ahmed MN, Al-Yahri O, Mahmood S, Consunji R, Al-Thani H. Clinical significance and prognostic implications of quantifying pulmonary contusion volume in patients with blunt chest trauma. Med Sci Monit. 2017;23:3641–8. PMID: 28746303

    Article  PubMed  PubMed Central  Google Scholar 

  27. Becher RD, Colonna AL, Enniss TM, Weaver AA, Crane DK, Martin RS, Mowery NT, Miller PR, Stitzel JD, Hoth JJ. An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma. J Trauma Acute Care Surg. 2012;73(5):1229–35.

    Article  PubMed  Google Scholar 

  28. Leblanc D, Bouvet C, Degiovanni F, Nedelcu C, Bouhours G, Rineau E, Ridereau-Zins C, Beydon L, Lasocki S. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med. 2014;40(10):1468–74. https://doi.org/10.1007/s00134-014-3382-9.

    Article  PubMed  Google Scholar 

  29. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–91.

    Article  PubMed  Google Scholar 

  30. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the berlin definition. JAMA. 2012;307(23):2526–33.

    Google Scholar 

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Authors and Affiliations

  1. Acute Care Surgery, Trauma, Burn, Surgical Critical Care, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA

    Umar Bhatti & Lena M. Napolitano

Authors
  1. Umar Bhatti
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  2. Lena M. Napolitano
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Correspondence to Lena M. Napolitano .

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Editors and Affiliations

  1. Medical College of Wisconsin, Froedtert Trauma Center, Milwaukee, WI, USA

    Marc de Moya

  2. Saint Alphonsus Regional Medical Center, Boise, ID, USA

    John Mayberry

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Bhatti, U., Napolitano, L.M. (2018). Lung Contusion Management: Invasive and Noninvasive. In: de Moya, M., Mayberry, J. (eds) Rib Fracture Management . Springer, Cham. https://doi.org/10.1007/978-3-319-91644-6_6

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  • DOI: https://doi.org/10.1007/978-3-319-91644-6_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91643-9

  • Online ISBN: 978-3-319-91644-6

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