Trauma remains the leading cause of death in developed countries in people younger than 45 years of age. Among trauma injuries blunt chest trauma is the second most frequent cause of death; almost 25% of all trauma patients who eventually die have trauma as a predominant or contributing factor. Blunt trauma injuries of the lung include lung contusions, lacerations, hematomas, and pulmonary vascular injuries. Here we review all blunt trauma injuries of the lung and focus especially on lung contusions. In more than 75% of cases, lung contusion is associated with rib fractures and flail chest. Lung contusion is an important clinical entity; it is an independent risk factor for the development of acute respiratory distress syndrome (ARDS), pneumonia, and long-term respiratory dysfunction, and is associated with a mortality rate of 10% to 25%. The main complications of lung contusion are respiratory failure, pneumonia, and ARDS. Though lung contusion is one of the independent risk factors for developing ARDS, alongside higher Injury Severity Score, large transfusion requirement, hypotension at admission, and advanced age, it does not seem to have a higher mortality rate. Treatment consists of judicious crystalloid or colloid resuscitation, epidural analgesia, and both non-invasive and invasive mechanical ventilation.
In this article, we review the concept of lung trauma, focusing on lung contusion and injury of the major bronchi. We expose the mechanism of injury, pathophysiology and associated injury that help to understand its management and treatment.
From the Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, Pere Virgili Health Institute and CIBER Enfermedades Respiratorias (CIBERES) Tarragona, Spain.
Address correspondence to: Monica Magret Iglesias, MD, Critical Care Department, Joan XXIII University Hospital, Carrer Dr. Mallafre Guasch 4, (43007) Tarragona, Spain. E-mail: email@example.com.