Lung contusion management: Invasive and noninvasive

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.