Lung Contusion in Polytrauma Patients
Objective. To pay attention to the timely diagnosis and adequate treatment of lung contusion in polytrauma patients.
Materials and Methods. 208 (52.6 %) out of 392 polytrauma patients had chest trauma. 68.9 % patients were younger than 39 years old. Lung contusion were in 86 (41.3 %). External respiration we estimate for respiratory rate, costosternal condition, percussion, auscultation data and blood oxygen saturation index.
Results and Discussion. Pulmonary contusion is characterized by hemorrhages in the lung tissue, with alveolar collapse, segmental pulmonary atelectasis, respiratory and haemodynamics disorders. This condition develops 24 hours after blunt trauma to the lungs and depended from lung tissue contusion volume. 41 trauma patients with the first and second degree lung contusions had satisfactory condition. 45 patients with severe lung contusions (III and IV degree) had traumatic shock and severe respiratory and cardiovascular failure. Significant lung contusion were diagnosed on plain chest X-ray, however was not significant difference between ARDS, fat embolism and pneumonia. Radiological signs of lung contusions do not correlate with clinical presentation in 2/3 polytrauma patients. Highly sensitive in detecting pulmonary contusions is CT. Therapeutic measures were direct to elimination of the respiratory and cardiovascular disorders, sanation of respiratory tracts, preventive of lung tissue hemorrhages infection and ensure adequate blood oxygenation. GCS less than 8, reduced concentration of oxygen in arterial blood less than 90 % and respiratory rate more than 30 per minute were indications to the tracheal intubation and mechanical ventilation. Tracheostomy and sanative bronchoscopy were necessary if tracheal intubation and mechanical ventilation were continued more then three days. Supportive care included prone position and surgical fixation of flail chest injury. In 4 patients with severe polytrauma and critical condition were perform minimum surgical intervention — fixation of flail chest by subcutaneous Kirshner wires. In another 19 patients were used original method of flail chest fixation — extrapleural ribs osteosyntesis by special crampons. These crampons perform fixation and compression of ribs fracture.
Conclusions. Lung contusion in polytrauma patients is the cause of the respiratory failure with 15.1 % mortality. Timely diagnostic and adequate treatment enables to stable patient’s condition and prevent life-threatening complications.
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