Pulmonary Contusion

Basics

Description

  • Transfer of kinetic energy to the lung, causing direct damage to the lung parenchyma, resulting in both hemorrhage and edema in the absence of a pulmonary laceration
  • Mortality rate is 10–25%
  • Independent risk factor for:
    • Acute respiratory distress syndrome
    • Pneumonia
    • Long-term respiratory dysfunction

Pathophysiology

  • Development of pulmonary contusion (PC):
    • Takes place in 2 stages:
      • First stage, which is related to the direct injury, results in alveolar hemorrhage and edema
      • Second stage is related to the indirect worsening of the injury as a result of measures that occur during the resuscitation of the patient, in particular, administration of IV fluids
  • Leads to:
    • Decreased lung compliance
    • Increased alveolar capillary permeability
    • Increased intrapulmonary shunting
    • Acute local and systemic inflammation
    • Hypoxemia, hypercarbia, acidosis
    • Increased respiratory work
    • Respiratory failure/ARDS

Etiology

  • Blunt or penetrating thoracic trauma
  • Sudden deceleration–compression
  • Fall from height
  • Motor vehicle accident
  • Assault
  • Missile

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