Management of thoracic trauma

Abstract

Managing major thoracic trauma begins with identifying and anticipating injuries associated with the mechanism of injury. The key aims are to reduce early mortality and the impact of associated complications to expedite recovery and restore the patient to their pre-injury state. While imaging is imperative to identify the extent of thoracic trauma, some pathology may require immediate treatment. The majority can be managed with adequate pleural drainage, but respiratory failure and poor gas exchange may require either non-invasive or invasive ventilation. Ventilation strategies to protect from complications such as barotrauma, volutrauma and ventilator-induced lung injury are important to consider. The management of pain is vital in reducing respiratory complications. A multimodal strategy using local, regional and systemic analgesia may mitigate respiratory side effects of opioid use. With optimal pain management, physiotherapy can be fully utilised to reduce respiratory complications and enhance early recovery. Thoracic surgeons should be consulted early for consideration of surgical management of specific injuries. With a greater understanding of the mechanisms of injury and the appropriate use of available resources, favourable outcomes can be reached in this cohort of patients. Overall, a multidisciplinary and holistic approach results in the best patient outcomes.

Spezielle intensivmedizinische Behandlungskonzepte des schweren Thoraxtraumas

“…Insbesondere in Bezug auf Lungenkontusionen ist die Sensitivität der CT im Vergleich zur Röntgenübersichtsaufnahme doppelt so hoch. In Anbetracht der Tatsache, dass Lungenkontusionen häufig erst nach etwa 6-24 h zur bildmorphologischen Darstellung kommen, findet die konventionelle Röntgendiagnostik im Rahmen der initialen Traumaversorgung meist "zu früh" statt [20]. In der CT sind sie meist jedoch sofort zu detektieren.…”

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

“…In thoracic trauma, the majority of patients can be managed conservatively [ 19 ]. In the NOM after thoracic trauma, there is not a general consensus when to follow-up the chest, usually depending on the patient clinical conditions; however, in clinical experience, they are prudentially re-evaluated in a short time (24–48 h), injuries likely to evolve, as those named before, or suspicious findings of such injuries as pneumomediastinum, extended pulmonary contusions, large pneumatoceles and hematoceles [ 20 ].…”