Management of bronchial and lung injury in multiply injured patients with chest trauma

ABSTRACT

Pulmonary and/or bronchial injuries due to chest trauma are not uncommon and occur in about 0.25% of patients. .In this study, the pattern of injury is analyzed and the importance of careful clinical examination outlined. Diagnosis is confirmed by means of plain chest X-ray and bronchoscopy.Between 1998 and 2000, 600 patients with a chest trauma were admitted to our University Hospital.In only 32 of them [0.5%], a ruptured bronchus and lug injury following chest trauma was identified. All patients had sustained severe associated injuries]. In five patients presenting with an extended subcutaneous emphysema at the time of admission, an air leakage persisted after immediate tube thoracostomy, one patient showed continuous tracheal bleeding. Diagnosis was confirmed bronchoscopically and an emergency thoracotomy performed in all 32 patients.In 14 patients the main bronchus was sutured, in 2 patient a wedge resection became necessary, and in one patient with additional lung laceration a lobectomy was performed. Twenty eight of 32 patients have survived and show no sequelae 3 months after trauma, respectively.Multiply injured patients with chest trauma presenting with an extended subcutaneous emphysema and persistent air leakage after tube thoracostomy are at high risk of lesions of the tracheo-bronchial tree. Bronchoscopy will confirm the diagnosis