Pulmonary Contusion

  • Scott Sattler
  • Ronald V. Maier


Pulmonary contusion is the most common potentially lethal chest injury. Pulmonary contusion is the result of direct trauma to the lung parenchyma with resulting ventilation to perfusion mismatch and hypoxemia. Focal areas of parenchymal injury, exacerbated by hypoventilation due to splinting of an injured thoracic cage, are the pathologic markers of pulmonary contusion. The pathophysiology, diagnostic approach, use of selective mechanical ventilatory management, rational pain control strategies and long-term outcomes of pulmonary contusion will be discussed.


Chest Wall Epidural Analgesia Nosocomial Pneumonia Chest Injury Pulmonary Contusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Selected References

  1. Bolliger CT, Van Eeden SF. Treatment of multiple rib fractures. Randomized controlled trial comparing ventilatory with nonventilatory management Chest. 1990;97:943–8.PubMedCrossRefGoogle Scholar
  2. Bongard FS, Lewis FR. Crystalloid resuscitation of patients with pulmonary contusion. Am J Surg. 1984; 148:145–51.PubMedCrossRefGoogle Scholar
  3. de Leon-Casasola OA, Parker B, Lema MJ, Harrison P, Massey J. Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients. Anesthesiology. 1994;81:368–75.PubMedCrossRefGoogle Scholar
  4. Desai PM. Pain management and pulmonary dysfunction. Crit Care Clin. 1999;15:151–66, vii.PubMedCrossRefGoogle Scholar
  5. Fulton RL, Peter ET. Compositional and histologic effects of fluid therapy following pulmonary contusion. J Trauma. 1974;14:783–90.PubMedCrossRefGoogle Scholar
  6. Guerrero-Lopez F, Vazquez-Mata G, Alcazar-Romero PP, Fernandez-Mondejar E, Aguayo-Hoyos E, Linde-Valverde CM. Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma. Crit Care Med. 2000;28:1370–5.PubMedCrossRefGoogle Scholar
  7. Hanning CD, Ledingham E, Ledingham IM. Late respiratory sequelae of blunt chest injury: a preliminary report. Thorax. 1981;36:204–7.PubMedCrossRefGoogle Scholar
  8. Kishikawa M, Yoshioka T, Shimazu T, Sugimoto H, Sugimoto T. Pulmonary contusion causes long-term respiratory dysfunction with decreased functional residual capacity. J Trauma. 1991;31:1203–8; discussion 1208–10.PubMedCrossRefGoogle Scholar
  9. Kishikawa M, Minami T, Shimazu T, et al. Laterality of air volume in the lungs long after blunt chest trauma. J Trauma. 1993;34:908–12; discussion 912–3.PubMedCrossRefGoogle Scholar
  10. Landercasper J, Cogbill TH, Lindesmith LA. Long-term disability after flail chest injury. J Trauma. 1984;24:410–4.PubMedCrossRefGoogle Scholar
  11. Luchette FA, Radafshar SM, Kaiser R, Flynn W, Hassett JM. Prospective evaluation of epidural versus intrapleural catheters for analgesia in chest wall trauma. J Trauma. 1994;36:865–9; discussion 869–70.PubMedCrossRefGoogle Scholar
  12. Mackersie RC, Shackford SR, Hoyt DB, Karagianes TG. Continuous epidural fentanyl analgesia: ventilatory function improvement with routine use in treatment of blunt chest injury. J Trauma. 1987;27:1207–12.PubMedCrossRefGoogle Scholar
  13. Mackersie RC, Karagianes TG, Hoyt DB, Davis JW. Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. J Trauma. 1991;31:443–9; discussion 449–51.PubMedCrossRefGoogle Scholar
  14. McRitchie DI, Matthews JG, Fink MP. Pneumonia in patients with multiple trauma. Clin Chest Med. 1995;16:135–46.PubMedGoogle Scholar
  15. Murphy DF. Interpleural analgesia. Br J Anaesth. 1993;71:426–34.PubMedCrossRefGoogle Scholar
  16. Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in childhood. Ann Surg. 1989;210:770–5.PubMedCrossRefGoogle Scholar
  17. Richardson JD, Franz JL, Grover FL, Trinkle JK. Pulmonary contusion and hemorrhage-crystalloid versus colloid replacement. J Surg Res. 1974;16:330–6.PubMedCrossRefGoogle Scholar
  18. Richardson JD, Woods D, Johanson WG, Jr., Trinkle JK. Lung bacterial clearance following pulmonary contusion. Surgery. 1979;86:730–5.PubMedGoogle Scholar
  19. Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusioa Ann Surg. 1982;196:481–7.PubMedCrossRefGoogle Scholar
  20. Shackford SR, Smith DE, Zarins CK, Rice CL, VirgiUo RW. The management of flail chest. A comparison of ventilatory and nonventilatory treatment. Am J Surg. 1976;132:759–62.PubMedCrossRefGoogle Scholar
  21. Short K, Scheeres D, Mlakar J, Dean R. Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. Am Surg. 1996;62:488–93.PubMedGoogle Scholar
  22. Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiol Clin North America. 2000;18:217–33, v.PubMedCrossRefGoogle Scholar
  23. Trinkle JK, Furman RW, Hinshaw MA, Bryant LR, Griffen WO. Pulmonary contusioa Pathogenesis and effect of various resuscitative measures. Ann Thorac Surg. 1973;16:568–73.PubMedCrossRefGoogle Scholar
  24. Virgilio RW, Rice CL, Smith DE, et al. Ciystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery. 1979;85:129–39.PubMedGoogle Scholar
  25. Wisner DH. A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia. J Trauma. 1990;30:799–804; discussion 804–5.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Scott Sattler
  • Ronald V. Maier

There are no affiliations available

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