Management of traumatic lung injury: A Western Trauma Association multicenter review

R. Karmy-Jones, G. J. Jurkovich, D. V. Shatz, S. Brundage, Jr Wall M.J., S. Engelhardt, D. B. Hoyt, J. Holcroft, M. M. Knudson

Research output: Contribution to journalArticle

91 Scopus citations

Abstract

Background: Improved outcomes following lung injury have been reported using "lung sparing" techniques. Methods: A retrospective multicenter 4-year review of patients who underwent lung resection following injury was performed. Resections were categorized as "minor" (suture, wedge resection, tractotomy) or "major" (lobectomy or pneumonectomy). Injury severity, Abbreviated Injury Scale (AIS) score, and outcome were recorded. Results: One hundred forty-three patients (28 blunt, 115 penetrating) underwent lung resection after sustaining an injury. Minor resections were used in 75% of cases, in patients with less severe thoracic injury (chest AIS scores "minor" 3.8 ± 0.9 vs. "major" 4.3 ± 0.7, p = 0.02). Mortality increased with each step of increasing complexity of the surgical technique (RR, 1.8; CI, 1.4-2.2): suture alone, 9% mortality; tractotomy, 13%; wedge resection, 30%; lobectomy, 43%; and pneumonectomy, 50%. Regression analysis demonstrated that blunt mechanism, lower blood pressure at thoracotomy, and increasing amount of the lung resection were each independently associated with mortality. Conclusion: Blunt traumatic lung injury has higher mortality primarily due to associated extrathoracic injuries. Major resections are required more commonly than previously reported. While "minor" resections, if feasible, are associated with improved outcome, trauma surgeons should be facile in a wide range of technical procedures for the management of lung injuries.

Original languageEnglish (US)
Pages (from-to)1049-1053
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number6
StatePublished - 2001
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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