Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma

Abstract

Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions.

The application of Pressure-regulated volume controlled ventilation mode in Video-assisted Thoracoscopic Surgery pulmonary segmentectomy

“…This strategy avoids excessive airway pressure to a certain extent, but there are still a few patients suffered high airway pressure under the condition of good position of double-lumen tubes 7 . High airway pressure could lead to increased alveolar pressure, which can reduce the amount of blood returned to the heart and then cause a drop in blood pressure [4,7]. Meanwhile, it can also induce airway injury, leading to acute lung injury and postoperative pulmonary complications.…”

“…intraoperative ventilator-associated lung injury has significantly reduced less than before [1][2][3][4].…”

Does the Diagnosis of Pulmonary Contusions Really Matter in the Modern ICU?

“…The investigators describe a daily fluid balance of 627-669 mL between the cohorts. 4 This is a relatively restrictive volume given that this also includes fluid provided during an average of 2 operations per subject. In contrast, blood product exposures seem common and high, with subjects receiving, on average, Ͼ800 mL of blood.…”

“…In contrast, blood product exposures seem common and high, with subjects receiving, on average, Ͼ800 mL of blood. 4 With crystalloid minimized and blood component therapy emphasized, one would expect the effects of pulmonary contusion to be negligible in the current era of damage control resuscitation with crystalloid minimization. Since the publication of the seminal ARDSnet trial, 16 the application of lung-protective ventilation has expanded to include those patients without clinical lung injury but at risk for it, in an effort to mitigate secondary injury by iatrogenic volutrauma.…”

“…In this issue of RESPIRATORY CARE, Dhar et al 4 investigated the effects of pulmonary contusions in 163 severely injured trauma subjects (chest abbreviated injury scale of Ն3), who required mechanical ventilation for at least 24 h. Of the cohort, Ͼ50% had pulmonary contusions identified by plain chest radiography and adjudicated by unanimous agreement of 3 blinded reviewers. Subject demographics, injury severity, and resuscitation characteristics (blood products and daily fluid balances) were well matched between those with and those without pulmonary contusions.…”