title: Management of traumatic lung injury: a Western Trauma Association Multicenter review.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Harborview Medical Center, Seattle, Washington 98104, USA. karmy@u.washington.edu
authors.forename: R
authors.initials: R
authors.lastname: Karmy-Jones
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: D V
authors.initials: DV
authors.lastname: Shatz
authors.forename: S
authors.initials: S
authors.lastname: Brundage
authors.forename: M J
authors.initials: MJ
authors.lastname: Wall
authors.forename: S
authors.initials: S
authors.lastname: Engelhardt
authors.forename: D B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: J
authors.initials: J
authors.lastname: Holcroft
authors.forename: M M
authors.initials: MM
authors.lastname: Knudson
mesh_terms: D000328:Adult; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008168:Lung / Q000601:surgery*; D055370:Lung Injury; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*