[Significance of lung contusion in mortality following polytrauma. Possibilities for therapeutic influence].
Multiple trauma is often associated with blunt thoracic injuries. Especially lung contusion can result in respiratory insufficiency and therefore a higher mortality rate. In our prospective study comparing 8 multiple trauma patients with and without associated lung contusion, we found that respiratory function was already significantly disturbed (decrease of paO2/FiO2 and increase of AaDO2, a rise in extravascular lung water (EVLW) both early after trauma and also with a second peak following the 4th day. This group (LK) developed significantly more cases of respiratory distress (ARDS). The disturbance of respiratory function seen initially was interpreted as a consequence of the direct mechanical impact, leading to the formation of interstitial fluid and hematoma. The frequent development of ARDS in the LK-group probably results from a pronounced activation of cellular and humoral mechanisms and therefore an enforced injury of the pulmonary capillary bed. A significant increase of pulmonary infections or the development of sepsis was not seen in the LK-group and is probably not responsible for the higher ARDS-rate in this group.
Regel
G
G
Unfallchirurgische Klinik, Medizinischen Hochschule Hannover.
Sturm
J A
JA
Friedl
H P
HP
Nerlich
M
M
Bosch
U
U
Tscherne
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D003288:Contusions / Q000401:mortality / Q000628:therapy*; D006801:Humans; D055370:Lung Injury; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors
Die Bedeutung der Lungenkontusion für die Letalität nach Polytrauma. Möglichkeiten der therapeutischen Beeinflussung.