title: Surgical management of traumatic pulmonary injury.
abstract: BACKGROUND
  Surgical treatment of traumatic pulmonary injuries requires knowledge of multiple approaches and operative interventions. We present a 15year experience in treatment of traumatic pulmonary injuries. We hypothesize that increased extent of lung resection correlates with higher mortality.
  
  
  METHODS
  Surgical registry data of a level 1 trauma center was retrospectively reviewed from 1984 to 1999 for traumatic lung injuries requiring operative intervention. Epidemiologic, operative, and hospital mortality data were obtained.
  
  
  RESULTS
  Operative intervention for traumatic pulmonary injuries was required in 397 patients, of whom 352 (89%) were men. Penetrating trauma was seen in 371 (93%) patients. Location of the injuries was noted in the left side of the chest in 197 (50%), right side of the chest in 171 (43%), and bilateral in 29 (7%). Operative interventions included pneumonorraphy (58%), wedge resection or lobectomy in (21%), tractotomy (11%), pneumonectomy (8%), and evacuation of hematoma (2%). Overall mortality was 27%. If concomitant laparotomy was required, mortality increased to 33%. The mortality rate in the pneumonectomy group was 69.7%.
  
  
  CONCLUSIONS
  The majority of lung injuries occurred in males due to penetrating trauma. Surgical treatment options ranged from simple oversewing of bleeding injury to rapid pneumonectomy. Mortality increased as the complexity of the operative intervention increased. Rapid intraoperative assessment and appropriate control of the injury is critical to the successful management of traumatic lung injury.
authors.affiliation: Michael E. Debakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston VA Medical Center, Houston, TX 77030, USA. jhuh@bcm.tmc.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Ernesto R
authors.initials: ER
authors.lastname: Soltero
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Mattox
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006406:Hematoma / Q000601:surgery; D006801:Humans; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery