Physiopathology of Crushed Chest Injuries

Garzon, Antonio A.; Seltzer, Bernard; Karlson, Karl E.

doi:10.1097/00000658-196807000-00015

Cited by 35 publications

(6 citation statements)

References 10 publications

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“…This dynamic course is comparable to observations in multiple trauma patients that regularly show a clinically relevant aggravation of pulmonary function at day 3 after trauma212223. While an initial decrease of pO 2 /FiO 2 might be explained by compensatory mechanisms (such as shunting and ventilation/perfusion mismatch during the acute posttraumatic phase) later impairments may be caused by local inflammatory changes inducing a marked increase in lung vascular and epithelial permeability and the translocation of protein-rich edema fluid into the air spaces1638394041. Therefore, we believe that the progressive deterioration with a significant decrease of the pO 2 /FiO 2 ratio at day 3 after trauma reflects the clinical situation.…”

Section: Discussionsupporting

confidence: 80%

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Horst

Simon

Pfeifer

et al. 2016

Sci Rep

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Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics.

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Section: Discussionsupporting

confidence: 80%

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Horst

Simon

Pfeifer

et al. 2016

Sci Rep

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“…By the end of the 1960s, the typical pathophysiology and plain radiographic findings associated with pulmonary contusion had been well delineated [28][29][30][31]. The experience of military surgeons during the Vietnam conflict provided further details about the role of high-velocity missiles and blast injuries as causative mechanisms for pulmonary contusion.…”

Section: Historymentioning

confidence: 99%

Pulmonary Contusion: An Update on Recent Advances in Clinical Management

2010

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Pulmonary contusion is a common finding after blunt chest trauma. The physiologic consequences of alveolar hemorrhage and pulmonary parenchymal destruction typically manifest themselves within hours of injury and usually resolve within approximately 7 days. Clinical symptoms, including respiratory distress with hypoxemia and hypercarbia, peak at about 72 h after injury. The timely diagnosis of pulmonary contusion requires a high degree of clinical suspicion when a patient presents with trauma caused by an appropriate mechanism of injury. The clinical diagnosis of acute parenchymal lung injury is usually confirmed by thoracic computed tomography, which is both highly sensitive in identifying pulmonary contusion and highly predictive of the need for subsequent mechanical ventilation. Management of pulmonary contusion is primarily supportive. Associated complications such as pneumonia, acute respiratory distress syndrome, and long-term pulmonary disability, however, are frequent sequelae of these injuries.

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“…Garzon [ 15 ] was one of the first to discuss the use of a tracheostomy combined with continuous mechanical ventilation. He analyzed a group of 12 patients with flail chest.…”

Section: Internal Supportmentioning

confidence: 99%

“…The typical paradoxical movement with decreased lung compliancy and the increased lung resistance that results in increased breathing effort are described in great detail. Moreover, the impaired venous return due to pressure changes within the chest is described [ 2 , 15 ]. Williams describes a typical clinical triad related to flail chest: intrabronchial hemorrhage, ineffectual cough and typical anoxia [ 44 ].…”

Section: Introductionmentioning

confidence: 99%

Historic overview of treatment techniques for rib fractures and flail chest

Bemelman

Poeze

Blokhuis

et al. 2010

Eur J Trauma Emerg Surg

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IntroductionFrom the beginning of the twentieth century till the current time, an overview is presented of the surgical treatment for rib fractures and flail chest.MethodsMany techniques have been used to stabilize the thorax wall. There has been no follow-up for the most described techniques and the evidence provided is at its best at L3–4. This, together with the noninvasiveness of mechanical ventilation, has made the latter the golden standard.ConclusionHowever, the recent introduction of better and fully dedicated materials provides the possibility of exploring the surgical treatment of chest injuries. The authors make a case for operative treatment of rib fractures and flail chest.

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Physiopathology of Crushed Chest Injuries

Cited by 35 publications

References 10 publications

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

Pulmonary Contusion: An Update on Recent Advances in Clinical Management

Historic overview of treatment techniques for rib fractures and flail chest

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