Pulmonary Alterations in the Acutely Injured Patient

Abstract

Alterations in pulmonary function in 10 patients following acute chest trauma were studied in a prospective manner in an attempt to determine the criteria for initiation and maintenance of respiratory support and to estimate residual impairment of pulmonary function. Commonly used factors such as central venous pressure, blood gas determinations, and chest roentgenograms were supplemented by serial xenon ventilation-perfusion lung scans in all patients. A definite correlation was found between the degree of trauma and alterations in lung function. Tracheostomy with assisted ventilation was required in 7 patients because of flail segments of the chest wall and hypoxia, and all had severe alterations in ventilation and perfusion. Repeat lung scan showed a return to normal as early as two months following injury. Late (mean, 1 year) follow-up lung scan and spirometry in 8 of the 10 patients demonstrated normal values in the majority. Serial blood gas determinations proved to be the best guide to adequacy of ventilation in patients with acute chest trauma.