title: Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma.
abstract: BACKGROUND
  Blunt chest trauma resulting in massive hemothorax requires immediate attention. We investigated the diagnostic and prognostic utility of various clinical factors in patients with deep pulmonary laceration caused by blunt chest trauma with a view toward interventional treatment.
  
  
  METHODS
  We reviewed 42 patients with deep pulmonary laceration resulting from blunt chest trauma who were treated between 1988 and 2008. Various clinical factors were compared between survivors and nonsurvivors.
  
  
  RESULTS
  Of the 42 patients, 29 (69%) survived. Median (25th, 75th percentile) systolic blood pressure at arrival was 102 (76, 121) mm Hg for survivors and 70 (60, 90) mm Hg for nonsurvivors (p = 0.015). The median heart rate at arrival was 107 (98, 120) beats/min for survivors and 130 (120, 140) beats/min for nonsurvivors (p = 0.014). Respiratory rate, Glasgow Coma Scale score, and arterial blood gas values did not affect prognosis. Blood loss through the chest tube at insertion was 500 (400, 700) mL for survivors and 700 (500, 1000) mL for nonsurvivors (p = 0.147) and within 2 hours of arrival was 850 (590, 1100) mm Hg and 1600 (1400, 2000) mL, respectively (p < 0.001). Blood loss during thoracotomy was 1170 (600, 1790) mL and 3500 (2000, 6690), respectively (p < 0.001).
  
  
  CONCLUSIONS
  In patients with deep pulmonary laceration, hemorrhagic shock with systolic blood pressure less than 80 mm Hg and heart rate more than 120 beats/min leads to a poor prognosis. Emergency thoracotomy and pulmonary lobectomy should be performed before the intrathoracic hemorrhage reaches 1200 mL.
authors.affiliation: Department of General Thoracic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan. nishiumi@is.icc.u-tokai.ac.jp
authors.forename: Noboru
authors.initials: N
authors.lastname: Nishiumi
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
authors.forename: Kana
authors.initials: K
authors.lastname: Oiwa
authors.forename: Ryouta
authors.initials: R
authors.lastname: Masuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006491:Hemothorax / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications*; D013908:Thoracotomy / Q000379:methods*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult