Research Progress of Flail Chest with Pulmonary Contusion_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUBo-fu ¹ , WANGXin ¹ , CHEGuo-wei ² ,  CAOYu ¹

1. Department of Emergency, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CAOYu, Email: dr.yu.cao@gmail.com

Keywords：

Pulmonary contusion; Flail chest with pulmonary contusion; Iconography change; Diagnosis and treatment advance

DOI：

10.7507/1007-4848.20150261

Video：

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Pulmonary contusion is frequent and a serious injury in the chest trauma patients in emergency department. And it is easy to induce acute respiratory distress syndrome (ARDS) and respiratory failure. Since the development of modern technology and transportation, flail chest with pulmonary contusion happens more frequently than the past. And its complications and mortality are higher. In order to understand it better and improve the effect of the therapy on flail chest with pulmonary contusion, we reviewed the relative literatures. In this article, the main contents are as followed:① The pathophysiological changes of pulmonary contusion; ② The pathophysiological changes of flail chest with pulmonary contusion; ③ Clinical manifestation of flail chest with pulmonary contusion; ④ Imaging change of flail chest with pulmonary contusion; ⑤ progress in diagnosis and treatment.

Citation： LIUBo-fu, WANGXin, CHEGuo-wei, CAOYu. Research Progress of Flail Chest with Pulmonary Contusion. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1056-1059. doi: 10.7507/1007-4848.20150261 Copy

1.	Michalska A,Jurczyk AP,Machała W,et al.Pulmonary contusion and acute respiratory distress syndrome(ARDS)as complications of blunt chest trauma.Arch Med Sadowej Kryminol,2009,59(2):148-154.
2.	Hamrick MC,Duhn RD,Ochsner MG.Critical evaluation of pulmonary contusion in the early post-traumatic period:risk of assisted ventilation.Am Surg,2009,75(11):1054-1058.
3.	Lai CC,Wang CY,Lin HI,et al.Pulmonary contusion associated with chest compressions.Resuscitation,2010,81(1):133.
4.	O'Connor JV,Kufera JA,Kerns TJ,et al.Crash and occupant predictors of pulmonary contusion.J Trauma,2009,66(4):1091-1095.
5.	Gayzik FS,Martin RS,Gabler HC,et al.Characterization of crashinduced thoracic loading resulting in pulmonary contusion.Trauma,2009,66(3):840-849.
6.	Wang ND,Stevens MH,Dory DB.Blunt chest trauma:an experimental model for heart and lung contusion.Trauma,2003,54(4):744-748.
7.	Oppenheimer L,Craven KD,Forkert L,et al.Pathophysiology of pulmonary contusion in dogs.J Appl Physiol Respair Environ Exerc Physiol,1979,47(4):718-728.
8.	Cohn SM,Stephen M.Pulmonary contusion:review of the clinical entity.Trauma,1997,42(5):973-979.
9.	Blentseh A,Ward PA.Regulation of experimental lung inflammation.Respiration Physiology,2001,128:17-22.
10.	Gorbunov NV,MeFaul SJ,Van Albert S.Assessment of inflammatory response and sequestration of blood iron transferrin complexes in a rat model of lung injury resulting from exposure to low-frequency shock waves.Crit Care Med,2004,32(4):1028-1034.
11.	James A.Russell genetic of coagulation factors in acute lung injury.Crit Care Med,2003,31(S):S243-S247.
12.	Groeneveld J.Vascular pharmacology of acute lung injury andacute respiratory distress syndrome.Vascular Pharmacology,2003,39(4-5):247-256.
13.	Davignon K,Kwo J,Bigatello LM.Pathophysiology and management of the flail chest.Minerva Anesthesiol,2004,70(4):193-199.
14.	Bastos R,Calhoon JH,Baisden CE.Flail chest and pulmonary contusion.Semin Thorac Cardiovasc Surg,2008,20(1):39-45.
15.	De Wever W,Bogaert J,Verschakelen J.Radiology of lung trauma.JBR-BTR,2000,83(4):167-173.
16.	Chardoli M,Hasan-Ghaliaee T,Akbari H,et al.Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma.Chin J Trauma,2013,16(6):351-354.
17.	Schild HH,Strunk H,Weber W,et al.Pulmonary contusion:CT vs plain radiograms.Comput Assist Tomogr,1998,13(3):417-420.
18.	Lomposchitz FM,Eisenhuber E,Linnau KF,et al.Imaging of chest trauma:radiological patterns of injury and dagnostic algorithms.Eur J Radiol,2003,48(1):61-70.
19.	Miller LA.Chest wall,lung,and pleural space trauma.Radiol Clin North Am,2006,44(2):213-224.
20.	Wanek S,Mayberry JC.Blunt thoracic trauma:flail chest,pulmonary contusion,and blast injury.Crit Care Clin,2004,20(1):71-81.
21.	Fulton RL,Peter ET.Physiologic effects of fluid therapy after pulmonary contusion.Am J Surg,1973,126(6):773-777.
22.	Trinkle JK,Furman RW,Hinshaw MA,et al.Pulmonary contusion.Pathogenesis and effect of various resuscitative measures.Ann Thorac Surg,1973,16(6):568-573.
23.	Cohn SM,Dubose JJ.Pulmonary contusion:an update on recent advances in clinical management.World J Surg,2010,34(8):1959-1970.
24.	Simon B,Ebert J,Bokhari F,et al.Management of pulmonary contusion and flail chest:an Eastern Association for the Surgery of Trauma practice management guideline.Trauma Acute Care Surg,2012,73(5 Supple 4):351-361.
25.	Cohn SM,Dubose JJ.Pulmonary contusion:an update on recent advances in clinical management.World J Surg,2010,34(8):1959-1970.
26.	Simon BJ,Cushman J,Barraco R,et al.Pain management guidelines for blunt thoracic trauma.Trauma,2005,59:1256-1267.
27.	Bulger EM,Edwards T,Klotz P,et al.Epidural an algesia improves outcome after multiple rib fractures.Surgery,2004,136(2):426-430.
28.	Trinkle JK,Furman RW,Hinshaw MA,et al.Pulmonary contusion.Pathogenesis and effect of various resuscitative measures.Ann Thorac Surg,1973,16(6):568-573.
29.	Christensson P,Gisselsson L,Lecerof H,et al.Early and late results of controlled ventilation in flail chest.Chest,1979,75(4):456-460.
30.	Sorkine P,Szold O,KlugerY,et al.Permissive hypercapnia ventilation in patients with severe pulmonary blast injury.Trauma,1998,45(1):35-38.
31.	Funk DJ,Lujan E,Moretti EW,et al.A brief report:the use of hjghfrequency oscillatory ventilation for severe pulmonary contusion.Trauma,2008,65(2):390-395.
32.	McGee EM,Trinkle JK.Pulmonary contusion-pathogenesis and current management.Rev Surg,1972,29(3):224.
33.	Sladen A,Aldredge CF,Albarran R.PEEP vs.ZEEP in the treatment of flail chest injuries.Crit Care Med,1973,1(4):187-191.
34.	Tanaka H,Tajimi K,Endoh Y,et al.Pneumatic stabilization for flail chest injury:an 11-year study.Surg Today,2001,31(1):12-17.
35.	Schweiger JW,Downs JB,Smith RA.Chest wall disruption with and without acute lung injury:effects of continuous positive airway pressure therapy on ventilation and perfusion relationships.Crit Care Med,2003,31(9):2364-2370.
36.	Bastos R,Calhoon JH,Baisden CE.Flail chest and pulmonary contusion.Semin Thorac Cardiovasc Surg,2008,20(1):39-45.
37.	Tanaka H,Yukioka T,Yamaguti Y,et al.Surgical stabilization of internal pneumatic stabilization?A prospective randomized study of management of severe flail chest patients.Trauma,2002,52(4):727-732.
38.	Voggenreiter G,Neudeck F,Aufmkolk M,et al.Operative chest wall stabilization in flail chest-outcomes of patients with or without pulmonary contusion.Am Coil Surg,1998,187(2):130-138.

1. Michalska A,Jurczyk AP,Machała W,et al.Pulmonary contusion and acute respiratory distress syndrome(ARDS)as complications of blunt chest trauma.Arch Med Sadowej Kryminol,2009,59(2):148-154.
2. Hamrick MC,Duhn RD,Ochsner MG.Critical evaluation of pulmonary contusion in the early post-traumatic period:risk of assisted ventilation.Am Surg,2009,75(11):1054-1058.
3. Lai CC,Wang CY,Lin HI,et al.Pulmonary contusion associated with chest compressions.Resuscitation,2010,81(1):133.
4. O'Connor JV,Kufera JA,Kerns TJ,et al.Crash and occupant predictors of pulmonary contusion.J Trauma,2009,66(4):1091-1095.
5. Gayzik FS,Martin RS,Gabler HC,et al.Characterization of crashinduced thoracic loading resulting in pulmonary contusion.Trauma,2009,66(3):840-849.
6. Wang ND,Stevens MH,Dory DB.Blunt chest trauma:an experimental model for heart and lung contusion.Trauma,2003,54(4):744-748.
7. Oppenheimer L,Craven KD,Forkert L,et al.Pathophysiology of pulmonary contusion in dogs.J Appl Physiol Respair Environ Exerc Physiol,1979,47(4):718-728.
8. Cohn SM,Stephen M.Pulmonary contusion:review of the clinical entity.Trauma,1997,42(5):973-979.
9. Blentseh A,Ward PA.Regulation of experimental lung inflammation.Respiration Physiology,2001,128:17-22.
10. Gorbunov NV,MeFaul SJ,Van Albert S.Assessment of inflammatory response and sequestration of blood iron transferrin complexes in a rat model of lung injury resulting from exposure to low-frequency shock waves.Crit Care Med,2004,32(4):1028-1034.
11. James A.Russell genetic of coagulation factors in acute lung injury.Crit Care Med,2003,31(S):S243-S247.
12. Groeneveld J.Vascular pharmacology of acute lung injury andacute respiratory distress syndrome.Vascular Pharmacology,2003,39(4-5):247-256.
13. Davignon K,Kwo J,Bigatello LM.Pathophysiology and management of the flail chest.Minerva Anesthesiol,2004,70(4):193-199.
14. Bastos R,Calhoon JH,Baisden CE.Flail chest and pulmonary contusion.Semin Thorac Cardiovasc Surg,2008,20(1):39-45.
15. De Wever W,Bogaert J,Verschakelen J.Radiology of lung trauma.JBR-BTR,2000,83(4):167-173.
16. Chardoli M,Hasan-Ghaliaee T,Akbari H,et al.Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma.Chin J Trauma,2013,16(6):351-354.
17. Schild HH,Strunk H,Weber W,et al.Pulmonary contusion:CT vs plain radiograms.Comput Assist Tomogr,1998,13(3):417-420.
18. Lomposchitz FM,Eisenhuber E,Linnau KF,et al.Imaging of chest trauma:radiological patterns of injury and dagnostic algorithms.Eur J Radiol,2003,48(1):61-70.
19. Miller LA.Chest wall,lung,and pleural space trauma.Radiol Clin North Am,2006,44(2):213-224.
20. Wanek S,Mayberry JC.Blunt thoracic trauma:flail chest,pulmonary contusion,and blast injury.Crit Care Clin,2004,20(1):71-81.
21. Fulton RL,Peter ET.Physiologic effects of fluid therapy after pulmonary contusion.Am J Surg,1973,126(6):773-777.
22. Trinkle JK,Furman RW,Hinshaw MA,et al.Pulmonary contusion.Pathogenesis and effect of various resuscitative measures.Ann Thorac Surg,1973,16(6):568-573.
23. Cohn SM,Dubose JJ.Pulmonary contusion:an update on recent advances in clinical management.World J Surg,2010,34(8):1959-1970.
24. Simon B,Ebert J,Bokhari F,et al.Management of pulmonary contusion and flail chest:an Eastern Association for the Surgery of Trauma practice management guideline.Trauma Acute Care Surg,2012,73(5 Supple 4):351-361.
25. Cohn SM,Dubose JJ.Pulmonary contusion:an update on recent advances in clinical management.World J Surg,2010,34(8):1959-1970.
26. Simon BJ,Cushman J,Barraco R,et al.Pain management guidelines for blunt thoracic trauma.Trauma,2005,59:1256-1267.
27. Bulger EM,Edwards T,Klotz P,et al.Epidural an algesia improves outcome after multiple rib fractures.Surgery,2004,136(2):426-430.
28. Trinkle JK,Furman RW,Hinshaw MA,et al.Pulmonary contusion.Pathogenesis and effect of various resuscitative measures.Ann Thorac Surg,1973,16(6):568-573.
29. Christensson P,Gisselsson L,Lecerof H,et al.Early and late results of controlled ventilation in flail chest.Chest,1979,75(4):456-460.
30. Sorkine P,Szold O,KlugerY,et al.Permissive hypercapnia ventilation in patients with severe pulmonary blast injury.Trauma,1998,45(1):35-38.
31. Funk DJ,Lujan E,Moretti EW,et al.A brief report:the use of hjghfrequency oscillatory ventilation for severe pulmonary contusion.Trauma,2008,65(2):390-395.
32. McGee EM,Trinkle JK.Pulmonary contusion-pathogenesis and current management.Rev Surg,1972,29(3):224.
33. Sladen A,Aldredge CF,Albarran R.PEEP vs.ZEEP in the treatment of flail chest injuries.Crit Care Med,1973,1(4):187-191.
34. Tanaka H,Tajimi K,Endoh Y,et al.Pneumatic stabilization for flail chest injury:an 11-year study.Surg Today,2001,31(1):12-17.
35. Schweiger JW,Downs JB,Smith RA.Chest wall disruption with and without acute lung injury:effects of continuous positive airway pressure therapy on ventilation and perfusion relationships.Crit Care Med,2003,31(9):2364-2370.
36. Bastos R,Calhoon JH,Baisden CE.Flail chest and pulmonary contusion.Semin Thorac Cardiovasc Surg,2008,20(1):39-45.
37. Tanaka H,Yukioka T,Yamaguti Y,et al.Surgical stabilization of internal pneumatic stabilization?A prospective randomized study of management of severe flail chest patients.Trauma,2002,52(4):727-732.
38. Voggenreiter G,Neudeck F,Aufmkolk M,et al.Operative chest wall stabilization in flail chest-outcomes of patients with or without pulmonary contusion.Am Coil Surg,1998,187(2):130-138.

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